212713 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
ONE CIVIC SQUARE NORTHERN SAFETY CO, INC
� CARMEL, INDIANA 46032 PO BOX 4250 CHECK AMOUNT: $262.27
UTICA NY 13504 CHECK NUMBER: 212713
ON�
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239012 900109435 119 . 99 SAFETY SUPPLIES
601 5023990 900116624 142 . 28 OTHER EXPENSES
NORTHERN Remember...We Always Offer
• Our Lowest Price When You Order. PLEASE REMIT To:
PO Box 4250 • Utica, NY 13504-4250 100%Satisfaction Guaranteed! 7MNORTHERN SAFETY CO.,INC.
Phone: 800.631.1246 • Fax: 800.635.1591 P.O. Box 4250
northernsafety.com Utica, NY 13504-4250
SHIP TO(IF OTHER THAN"SOLD TO")
YOUR CUSTOMER ID
• • • • - • - • Carmel Water Distribution
3217619 Andy
5484 E 126TH ST
SOLD CARMEL IN 46033-9289
TO: Carmel Water Distribution
USA
3450 W 131st St
CARMEL IN 46074-8267
USA
andy 08/29/2012
YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 09/28/2012
INVOICE NO./ORDER NO.
900116624/100068282 08/29/2012 FEDEX GROUND 08/29/2012 IF PAID BY 09/18/2012 PAY $ 139.68
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
2 2 3122210 PR MEN STEEL TOE SNEAKER M WTH SZ 10 FR 64.95 129.90
1 1 SP2012CAT EA 2012 CATALOG KIT 0.00 0.00
SALES TAX SHIPPING&HANDLING
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 11/2%PER
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE
UNPAID BALANCE. $ 0.00 $ 12.38 $ 142.28
Payments must be payable in US dollars only _ _ _ 6 _ _ _ _
"2%discount does not apply to credit card payments Th®nk You Tor Y®ur �ralE
FEDERAL ID#16-1214814
VOUCHER # 122043 WARRANT # ALLOWED
226500 IN SUM OF $
NORTHERN SAFETY CO, INC
PO BOX 4250
UTICA, NY 13504
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
900116624 01-6200-03 $142.28
t
Voucher Total $142.28
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
226500
NORTHERN SAFETY CO, INC Purchase Order No.
PO BOX 4250 Terms
UTICA, NY 13504 Due Date 9/4/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/4/2012 900116624 $142.28
I 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 ewcer
KJORTHERN Remember... We Always Offer
• Our Lowest Price When You Order. PLEASE REMIT TO:
PO Box 4250 • Utica, NY 13504-4250 100%Satisfaction Guaranteed! NORTHERN SAFETY CO., INC.
Phone: 800.631 .1246 • Fax: 800.635.1591 P.O. Box 4250
northernsafety.com Utica, NY 13504-4250
SHIP TO(IF OTHER THAN"SOLD TO")
• • • • • • • YOUR CUSTOMER ID Carmel Clay Parks&Recreation
4816021 Nikesha
4311 E. 1 16th Street
SOLD CARMEL IN 46033-3353
TO: Carmel Clay Parks&Recreation
1411 E 116TH ST USA
CARMEL IN 46032 AU� 2 7
USA 2012
E0002795 08/23/2012
L BY:-
YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 09/22/2012
INVOICE NO./ORDER NO.
900109435/980032566 08/23/2012 FEDEX GROUND 08/23/2012 IF PAID BY 09/12/2012 PAY $ 117.83
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
4 4 22078 L BX FLEXSHIELD PF PREM VINYL GLV 100BX L 6.09 24.36
2 2 24778 EA 1st AID SPRAY HYDROGEN PEROXIDE HP2-24 2.80 5.60
2 2 1759 EA BANDAGE SCISSOR SS STEEL 5.5' 3.29 6.58
3 2 7259 BX STERILE PADS 2"X 2'' 100BX 9.79 19.58
5 5 7804 RL 3M COBAN SLF ADHERENT WRAP 2"X5YD RL 2.97 14.85
5 5 6115 EA STRETCH GAUZE BANDAGE 2'X 2 YD 2.01 10.05
2 2 31962 BX NS TRIPLE ANTIBOITIC CREAM 20/BX 3.60 7.20
4 4 31963 EA NS TRIANGULAR BANDAGE 1.80 7.20
5 5 Pu cha 799 EA IRRIGATE EYE WASH 1 OZ 19828 2.50 12.50
Ds 0 cription
P _P r F
G. .# �r7
BU. t
Li Descr
Q[5'OM PU chaser nDa te
ACCOUNTS 30 DAYS Qf� I FR%E-6t=-9'ffiir PER SALES TAX SHIPPING&HANDLING • •
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE
UNPAID BALANCE. $ 0.00 $ 12.07 $ 119.99
Payments must be payable in US dollars only
"2%discount does not apply to credit card payments Thank You for Your ®r_d6d
FEDERAL ID#16-1214814
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
226500 Northern Safety Co., Inc. Terms
P.O. Box 4250
Utica, NY 13504-4250
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
8/23/12 900109435 Safety supplies $ 119.99
Total $ 119.99
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.
226500 Northern Safety Co., Inc. Allowed 20
P.O. Box 4250
Utica, NY 13504-4250
In Sum of$
$ 119.99
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-11 900109435 4239012 $ 119.99 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
6-Sep 2012
Signature
$ 119.99 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund