213115 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
' ONE CIVIC SQUARE NORTHERN SAFETY CO, INC
CHECK AMOUNT: $51.91
CARMEL, INDIANA 46032 PO BOX 4z5o
oN ,r UTICA NY 13504 CHECK NUMBER: 213115
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 900127302 51. 91 GENERAL PROGRAM SUPPL
NORTHERN 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 e Fax: 800.635.1591 P.O. Box 4250
northernsafety.com Utica, NY 13504-4250
SHIP TO(IF OTHER THAN"SOLD TO")
YOUR CUSTOMER ID
- e • • - • • Carmel Clay Parks&Recreation
4816021 Cyndi
4242 E. 126th Street
SOLD CARMEL IN 46033-2450
TO: Carmel Clay Parks&Recreation
1411 E 116TH ST USA
-��.,��� T'A'D L
CARMEL IN 46032
USA SEP 13 2012
E0002826 09/07/2012
L FY- YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED
INVOICE No./ORDER No. PAYMENT DUE BY 10/07/2012
900127302/980038588 09/07/2012 FEDEX GROUND 09/07/2012 IF PAID BY 69/27/2012 PAY $ 51.1 1
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
2 2 1580 BX FABRIC STRIPS 3/4 X 3 100BX 1580033 4.49 8.98
1 1 1070 BX EX.LG PLSTC STRIPS 2 X 4 1/2 1070033 4.65 4.65
2 2 30918 BX BZK ANTISEPTIC WIPES 100BX 1303 2.69 5.38
1 1 10319 L BX TNT BE POWDR FREE NITRILE GLV L 92-675 13.95 13.95
2 2 31962 BX NS TRIPLE ANTIBOITIC CREAM 20/BX 3.60 7.20
Purchase `
Description U d
P.O.# E.00C>2•$2' P o0
G.L.# I bm S- d 4'2:�0a9-
Budget
Line Descr//�� n
Purchaserll✓ A1, � Date
Approval Data
SALES TAX SHIPPING&HANDLING o
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 1'/,%PER
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE
UNPAID BALANCE. $ 0.00 $ 11.75 $ 51.91
Payments must be payable in US dollars only
"2%discount does not apply to credit card payments Thank You for Your Order!
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
9/7/12 900127302 Supplies $ 51.91
Total $ 51.91
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$
$ 51.91
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept.#
1081-5 900127302 4239039 $ 51.91 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
20-Sep 2012
Signature
$ 51.91 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
'A.