215119 12/04/2012 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: $41.44
UTICA NY 13504 CHECK NUMBER: 215119
ON 0
CHECK DATE: 12/4/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4238900 900203897 41 .44 OTHER MAINT SUPPLIES
�f�IJLS L 5�l`"l Remember...We Always Offer
WIMWii
• 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
••e o
4816021 Matthew
1235 CENTRAL PARK DRIVE EAST
TOLD CARMEL IN 46032 4421
Carmel Clay Parks&Recreationy� _�_
USA
1411 E 116TH ST
CARMEL IN 46032 NOV 16 2012 L
USA
MC003503 11/09/2012
L - YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 12/09/2012
INVOICE NO./ORDER NO.
00203897/980063312 11/09/2012 FEDEX GROUND 11/09/2012 IF PAID BY 11/29/2012 PAY $40.81
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
1 1 26521 EA ZTEK EYEWR CLR LENS S2510S 2.43 2.43
1 1 26523 EA ZTEK EYEWR GY LENS s2520s 2.80 2.80
1 1 21543 EA SPLASH GOGGLES 4401-400 2.69 2.69
1 1 26019 L PR MECHANIX UTIL GLV L 23.36 23.36
Purchase PERSonqL PR.areq'ioN
Description ECRU 1 Prn EnT
P.o.# W,00350 P 0/2\
G.L.# 1093 . 4233goo
Budget
Line Descr
Purchaser Date
Approval Date
SALES TAX SHIPPING&HANDLING •
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 1112%PER
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE - $- 0.00 - $ 10.16 $ 41.44
UNPAID BALANCE. `-
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
119/12 900203897 Personal protection equipment $ 41.44
Total $ 41.44
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
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$
$ 41.44
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1093 900203897 4238900 $ 41.44 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
i
29-Nov 2012
Signature
$ 41.44 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
i
I