212380 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 363840 Page 1 of 1
t ONE CIVIC SQUARE STATE SAFETY&COMPLIANCE LLC CHECK AMOUNT: $216.50
CARMEL, INDIANA 46032 5338 VICTORY DRIVE STE A
INDIANAPOLIS IN 46203 CHECK NUMBER: 212380
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 9944056 64 . 95 OTHER EXPENSES
651 5023990 9944081 116 . 16 OTHER EXPENSES
651 5023990 9944082 35 . 39 OTHER EXPENSES
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INVOICE
State Safety & Compliance, LLC.
INVOICE
Branch: 701 Indianapolis 9944056
5338 Victory Dr Invoice Date Page
Suite A 8/7/2012 09:31:51 1 of 1
Indianapolis, IN 46203 ORDER NUMBER
3641495
317-423-7724
Bill To: Ship To: **DIRECT SHIPMENT**
City of Cannel Utilities City of Cannel Utilities
Wastewater Carmel W.W.T.P(PO 513176)
760 Third Ave. SW, Suite 110 9609 Hazel Dell Parkway
Carmel, IN 46032 Indianapolis, In 46280
Customer Fn: 109095
PO Number Terms Description Net Due Date Disc Due Date Discount Amount
S13176 0.5% 10 net 30 09/06/12 08/17/12 0.26
Order Date Pick Ticket No Primary Salesrep Name Taker
7/25/2012 08:29:53 5950608 Rob Willmann JCHANEY
Quantities Pricing
Item ID UOM Unit Extended
Ordered Shipped Remaining UU 4 Item Description Unit Size Price Price
Unit Size O
Delivery Instructions: UPS GROUND PREPAY&ADD
Carrier: UPS Ground-PPA Tracking#:IZ09X9240377336294
4.0000 4.0000 0.0000 EA LUX-SSCOOLG-XL EA 13.1300 52.52
1.0 VEST YELLOW COOL MESH W/STRIPE SZ XL 1
Totai%uses:1 S Ul%-TOIAL: 52.52
Total Freight In:0.00 Total Freight Otit:12.43 TOTAL FREIGHT: 12.43
TAX. 0.00
41610UNT DUE: 64.95
ORIGINAL
INVOICE
State Safety & Compliance, LLC.
INVOICE
Branch: 701 Indianapolis 9944081
5338 Victory Dr Invoice Date Page
Suite A 8/7/2012 09:41:41 1 of 1
Indianapolis, IN 46203 ORDER NUMBER
3641495
317-423-7724
Bill To: 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 iir 109095
PO Number Terms Description Net Due Date Disc Due Date Discount Amount
S13176 0.5% 10 net 30 09/06/12 08/17/12 0.58
Order Date Pick Ticket No Primary Salesrep Name Taker
7/25/2012 08:29:53 5950625 Rob Willmann JCHANEY
Quantities Pricing
Item ID UOM Unit Extended
Ordered Shipped Remaining UOM 4 Item Description Unit Size Price Price
Unit Size 1 C
Delivery Instructions: UPS GROUND PREPAY&ADD
Carrier: UPS Ground-PPA Tracking#:
12.0000 12.0000 0.0000 EA 51KBR EA 9.6800 116.16
1.0 HARDHAT KENTKY BLUE 4PT SUSPN RATCHET 1
W/RAIN TROUGH
Total Lines:I SUBTOTAL: 116.16
TAX: 0.00
AMOUNT DUE: 116.16
ORIGINAL
INVOICE
State Safety & Compliance, LLC.
INVOICE
Branch: 701 Indianapolis 9944082
5338 Victory Dr Invoice Date Page
Suite A 8/7/2012 09:42:24 1 of 1
Indianapolis, IN 46203 ORDER NUMBER
3641495
317-423-7724
Bill To: 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 iii: 109095
PO Number Terms Description Net Due Date Disc Due Date Discount Amount
S13176 0.5% 10 net 30 09/06/12 08/17/12 0.17
Order Date Pick Ticket No Primary Salesrep Name Taker
7/25/2012 08:29:53 5950626 Rob Willmann JCHANEY
Quantities Pricing
Item ID UOM Unit Extended
4 Item Description Price Price
Ordered Shipped Ren+aini+rg UOM Unit Size
Unit Size O
Delivery Instructions: UPS GROUND PREPAY&ADD
Carrier: UPS Ground- PPA Tracking#:
4.0000 4.0000 0.0000 EA RIV2003-2XL EA 8.4000 33.60
1.0 RAINSUIT CLASSIC.35MM 3 PIECE PVC 1
JACKET W/ DETACHABLE HOOD & BIB
PANTS
Total Lines:I SUB-TOTAL: 33.60
Total Freight In:0.00 Total Freight Out:1.79 TOTAL FREIGHT: 1.79
TAX: 0.00
AMOUNT DUE: 35.39
ORIGINAL
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 8/21/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/21/2012 9944081 $116.16
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
Date Officer
VOUCHER # 125510 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
9944081 01-7202-06 $116.16
71Ngi)8q 01.-)a0a.o6 , 35-m
799905(5 01. 7doa•06
oil(0, So
Voucher Total A
Cost distribution ledger classification if
claim paid under vehicle highway fund