211955 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 363840 Page 1 of 1
ONE CIVIC SQUARE STATE SAFETY&COMPLIANCE LLC
' CARMEL, INDIANA 46032 5338 VICTORY DRIVE STE A CHECK AMOUNT: $467.55
INDIANAPOLIS IN 46203 CHECK NUMBER: 211955
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 9940374 191 . 72 OTHER EXPENSES
651 5023990 9941980 137 .37 OTHER EXPENSES
651 5023990 9941981 138 . 46 OTHER EXPENSES
INVOICE
State Safety & Compliance, LLC. INVOICE
Branch: 701 Indianapolis 9941981
5338 Victory Dr Invoice Date Page
Suite A 7/31/2012 09:37:04 1 of 1
Indianapolis, IN 46203 ORDER NUMBER
3641495
-7724
317-423
Bill 23 Ship To: "DIRECT SHIPMENT"
City of Carmel Utilities City of Carmel Utilities
Wastewater Carmel W.W.T.P(PO S13176)
760 Third Ave. SW, Suite 110 9609 Hazel Dell Parkway
Carmel, IN 46032 Indianapolis, In 46280
Customer ID: 109095
PO Number Terms Description Net Due Date Disc Due Date Discount Amount
S13176 0.5% 10 net 30 08/30/12 08/10/12 0.65
Order Date Pick Ticket No Primary Salesrep Name Taker
7/25/2012 08:29:53 5948507 Rob Willmann JCHANEY
Quantities Pricing
Item ID UOM Unit Extended
Ordered Stripped Remaining UOM 4 Itent Description Unit Si„e Price Price
Unit Size 1 O
Delivery Instructions: UPS GROUND PREPAY&ADD
Carrier: UPS Ground-PPA Tracking#:
1.0000 1.0000 0.0000 DZ WCHV0500-L DZ 45.0000 45.00
1.0 GLOVES HI-VIZ COWHIDE PREMIUM 6DZ/CS 1
RUBBERIZED SAFETY CUFF; 2 STRIPES OF
REFLECTIVE TAPE...WING THUMB
1.0000 1.0000 0.0000 DZ WCHV0990K-L DZ 85.0000 85.00
1.0 GLOVES HI-VIZ LEATHER DRIVER IODZ/CS 1
2.1" REFLECTIVE SRIPE W/ A 3/4" GREEN
BAND IN THE MIDDLE...KEYSTONE THUMB
Total Lines:2 SUB-TOTAL: 130.00
Total Freight/n:0.00 Total Freight Out:8.46 TOTAL FREIGHT: 8.46
TAX. 0.00
AMOUNT DUE: 138.46
ORIGINAL
INVOICE
State Safety & Compliance, LLC.
INVOICE
Branch: 701 Indianapolis 9941980
5338 Victory Dr Invoice Date Page
Suite A 7/31/2012 09:31:14 1 of 1
Indianapolis, IN 46203 ORDER NUMBER
3641495
317-423-7724 "DIRECT SHIPMENT"
Bill To: Ship To:
City of Carmel Utilities City of Carmel Utilities
Wastewater Carmel W.W.T.P(PO S13176)
760 Third Ave. SW, Suite 110 9609 Hazel Dell Parkway
Carmel, IN 46032 Indianapolis, In 46280
Customer ID: 109095
PO Number Terms Description: Net Due Date I Disc Due Date Discount Amount
S13176 0.5% 10 net 30 08/30/12 08/10/12 0.62
Order Date Pick Ticket No Primary Salesrep Name Taker
7/25/2012 08:29:53 5948504 Rob Willmann JCHANEY
Quantities Prich
Item ID UOM Unit Extended
Ordered Shipped Remaining UOM y Item Description Unit Size Price Price
Unit Size O
Delivery Instructions: UPS GROUND PREPAY&ADD
Carrier: UPS Ground-PPA Tracking#:
1.0000 1.0000 0.0000 DZ ANS37-165-10 DZ 64.1600 64.16
1.0 GLOVES SOLVEX NITRILE 22MIL 15" UNLINED 1
CHEMICAL RESISTANT
4.0000 4.0000 0.0000 EA RIV2003-XL EA 8.0600 32.24
1.0 RAINSUIT CLASSIC.35MM 3 PIECE PVC 1
JACKET W/ DETACHABLE HOOD & BIB
PANTS
3.0000 3.0000 0.0000 DZ MCR7810 DZ 9.2800 27.84
1.0 GLOVES BROWN JERSEY MEN DOTTED PVC 1
Total Lines:3 SUB-TOTAL: 124.24
Total Freight/n:0.00 Total Freight Out:13.13 TOTAL FREIGHT. 13.13
TAX. 0.00
AMOUNT DUE: 137.37
ORIGINAL
INVOICE
State Safety & Compliance, LLC.
INVOICE
Branch: 701 Indianapolis 9940374
5338 Victory Dr Invoice Date Page
Suite A 7/25/2012 14:33:02 1 of 1
Indianapolis, IN 46203 ORDER NUMBER
3641495
317-423-7724
Bill To: Ship To:
City of Carmel Utilities City of Carmel Utilities
Wastewater Carmel W.W.T.P(PO S13176)
760 Third Ave. SW, Suite 110 9609 Hazel Dell Parkway
Carmel, IN 46032 Indianapolis, In 46280
rs*c::c:=T,►3:
!09095 -- — -
PO Number Terms Description Net Due Date Disc Due Date Discount Amount
S13176 0.5% 10 net 30 08/24/12 08/04/12 0.92
Order Date Pick Ticket No Primaty Salesrep Name Taker
7/25/2012 08:29:53 5946717 Rob Willmann 7CHANEY
Quantities Pricing
Item ID Mitt Unit Extended
Ordered Shipped Remaining UOM 4 Item Description Unit Size Price Price
Unit Size O
Delh,ety Instructions: UPS GROUND PREPAY&ADD
Carrier: UPS Ground-PPA Tracking#:IZ203YOA0354661 1 18
1.0000 1.0000 0.0000 CS TY127SWH002500-2XL CS 133.4300 133.43
1.0 COVERALL TYVEK ZPR ELS WRS/ANK HD(25/C) 1
6.0000 6.0000 0.0000 EA SP-QM24+ EA 6.0600 36.36
1.0 EARMUFF MULTI-POSITION NRR25 DIELECTRIC 1
MULTIPLE POSITION HEADBAND NRR25
DIELECTRIC EARMUFF HOWARD LEIGHT
(UPC#033552006138)QM24+(20/CS)
1.0000 1.0000 6.0000 BX 3M8210 BX 13.8900 13.89
20.0 RESPIRATOR DUST DISP.(20/BOX-8/CASE) 20
DUST MASK, DISPOSABLE
Total Lines:3 SUB-TOTAL: 183.68
Total Freight In:0.00 Total Freight Out:8.04 TOTAL FREIGHT: 8.04
TAX: 0.00
AMOUNT DUE: 191.72
ORIGINAL
VOUCHER # 125451 WARRANT # ALLOWED
363840 IN SUM OF $
STATE SAFETY & COMPLIANCE LLC
5338 VICTORY DRIVE STE A
INDIANAPOLIS, IN 46203
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
9940374 01-7202-06 $191.72
9�gjgSo vl-7aoa-06 (3-7.3_1
`�9y1981 01 -7ao)-o�
Voucher Total
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board'of Accounts City Form No.201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL'
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
363840
STATE SAFETY& COMPLIANCE LLC Purchase Order No.
5338 VICTORY DRIVE STE A Terms
INDIANAPOLIS, IN 46203 Due Date 8/2/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
i
8/2/2012 9940374 $191.72
I
hereby certify that the attached invoice(s), or bill(s) is (are) true and
;orrect and I have audited same in accordance with IC 5-11-10-1.6
Date Officer