213182 09/25/2012 f CITY OF CARMEL, INDIANA VENDOR: 363840 Page 1 of 1
ONE CIVIC SQUARE STATE SAFETY&COMPLIANCE LLC CHECK AMOUNT: $646.81
CARMEL, INDIANA 46032 5338 VICTORY DRIVE STE A
•+ .o�.�o INDIANAPOLIS IN 46203 CHECK NUMBER: 213182
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 9954560 646 . 81 OTHER EXPENSES
INVOICE
State Safety & Compliance, LLC.
INVOICE
Branch: 701 Indianapolis 9954560
5338 Victory Dr Invoice Date Page
Suite A 9/11/2012 15:33:15 1 of 1
Indianapolis, IN 46203 ORDER NUMBER
3650382
317-423-7724
Bill To: Ship To: **DIRECT SHIPMENT**
City of Carmel Utilities City of Carmel Utilities--Carmel W.W.T.P
Wastewater ATTN: JEFF COOPER(PO S13230)
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
S13230 0.5% 10 net 30 10/11/12 09/21/12 3.18
Order Date Pick Ticket No Primary Salesrep Name Taker
9/6/2012 14:56:29 5961109 Rob Willmann JCHANEY
Quantities Pricing
Item ID UOM Unit Extended
Ordered Shipped Remaining UOM 4 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 EA GS-03-A-012-G/C EA 636.8100 636.81
1.0 MONITOR GASMAN OZONE RECHARGEABLE 1
Total Lines.-I SUB-TOTAL: 636.81
Total Freight In:0.00 Total Freiglit Out:10.00 TOTAL FREIGHT: 10.00
TAX. 0.00
AMOUNT DUE: 646.81
ORIGINAL
VOUCHER # 125709 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
9954560 01-7202-06 $646.81
Voucher Total $646.81
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 9/19/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/19/2012 9954560 $646.81
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
12-
Date Officer