214665 11/20/2012 - CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
ONE CIVIC SQUARE HALSEN PRODUCTS CHECK AMOUNT: $1,714.23
CARMEL, INDIANA 46032 PO BOX 877
BELMONT MS 38827 CHECK NUMBER: 214665
CHECK DATE: 11/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4239011 0116605-IN 1, 714 . 23 SPECIAL DEPT SUPPLIES
HALSEN PRODUCTS COMPANY INVOICE PAGE: 1
P.O.BOX 877
BELMONT,MS 38627
NATIONWIDE 1-800-344-6696 INVOICE NUMBER:
FAX 1-800-826-8639 0116605-IN
INVOICE DATE: 10/31/2012
ORDER NUMBER:
ORDER DATE:
SALESPERSON: 0523
CUSTOMER NO: 0230327
SOLD TO SHIP TO
CITY OF CARMEL STREET DEPARTMENT
ATTENTION ACCOUNTS PAYABLE BONNIE CALLAHAN
3400 W 131ST ST 3400 WEST 131 STREET
Westfield, IN 46074 Westfield, IN 46074
CONFIRM TO:
BONNIE_
CUSTOMER P.O. SHIP VIA F.O:B. TERMS
BONNIE UPS
Net 30
ITEM NO. UNIT ORDERED SHIPPED BACKORDER PRICE AMOUNT
65OR1-0 EACH 50 50 0 30.900 1545 .00
NAVICADE CHANNE IZER CONE
650-RB16 EAC 50 50 0 0 .000 0.00
NAVICADE 16LB BASE
*
EACf 1 1 0 0. 000 0. 00
2- 4" WHITE EG 3TRIPES ON EACH
CONE
Net Invoice 1545 .00
THANK YOU FOR YOUR ORDER ! !
Freight 169.23
Sales Tax 0.00
Invoice Total 1714 .23
Less Deposit 0. 00
1:114 2:1
INVOICE BALANCE
VOUCHER NO. WARRANT NO.
ALLOWED 20
Halsen Products
IN SUM OF $
P. O. Box 877
Belmont, MS 38827
$1,714.23
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I 0116605-IN I 42-390.111 $1,714.23 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
Thursday,/November 15, 2012
Stre8et Commissioner
-'rapt (,nimmn iss ion er
Title
Cost distribution ledger classification if
claim paid motor 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 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))
10/31/12 0116605-IN $1,714.23
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