212245 08/28/2012 \,f CITY OF CARMEL, INDIANA VENDOR: 366314 Page 1 of 1
ONE CIVIC SQUARE HUGHES SAFETY INC CHECK AMOUNT: $234.00
CARMEL, INDIANA 46032 2365 BILL SMITH ROAD
MARTINSVILLE IN 46151 CHECK NUMBER: 212245
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4350900 2012-0056 234 . 00 OTHER CONT SERVICES
HUGHES SAFETY INCORPORATED Invoice
2365 BILL SMITH RD
Date Invoice#
MARTINSVILLE, IN 46151
317-538-7373 8/22/2012 2012-0056
Bill To
CARMEL FIRE DEPARTMENT
BOB VANVOORST
2 CIVIC SQUARE
CARMEL,IN 46032
P.O. No. Terms Project
Net 30
Quantity Description Rate Amount
I DUO-SAFETY ROOF LADDER HOOKS 114.00 114.00
1 MISC.LADDER SERVICE,CUT DOWN 16'ROOF LADDER TO CREATE A 14' 20.00 20.00
LADDER. REINSTALL FEET AND RIVETS.
1 MISC.LADDER SERVICE,CUT DOWN OLD BASE SECTION TO 8'TO MAKE 40.00 40.00
TRAINING SIMULATOR LADDER, INSTALLED HOOKS AND BEAM PLATES.
HOOKS TESTED TO IOOOLBS FOR 1 MIN.
60 TRIP CHARGE,PER MILE 1.00 60.00
Total $234.00
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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2012-0056 $234.00
1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO,
ALLOWED 20
Hughes Safety Inc.
IN SUM OF $
2365 Bill Smith Road
Martinsville, IN 46151
$234.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I 2012-0056 I 43-509.00 I $234.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
AUG 2 7 2012
r /7 d
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund