218069 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
0 ONE CIVIC SQUARE HALSEN PRODUCTS
CARMEL, INDIANA 46032 PO BOX 877 CHECK AMOUNT: $220.14
?� BELMONT MS 38827
CHECK NUMBER: 218069
CHECK DATE: 3/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4356001 0117860-IN 220 . 14 UNIFORMS
1
HALSEN PRODUCTS COMPANY 114VIC PAGE:
P.O.BOX 877
BELMONT,MS 38827
NATIONWIDE 1-800-344-6696 INVOICE NUMBER:
FAX 1-800-826-8839 0117860-IN
INVOICE DATE: 2/28/2013
ORDER NUMBER:
ORDER DATE:
SALESPERSON: 0523
CUSTOMER NO: 0230327
SOLD TO SHIP TO
CITY OF CARMEL STREET DEPARTMENT
ATTENTION ACCOUNTS PAYABLE AMY LUNN
3400 W 131ST ST 3400 WEST 131 STREET
Westfield, IN 46074 Westfield, IN 46074
CONFIRM TO:
AMY LUNN
CUSTOMER P.O. SHIP VIA F.0.8. TERMS
AMY UPS
Net 30
ITEM NO. UNIT ORDERED SHIPPED BACK ORDER PRICE* AMOUNT
BJM92K EACH 288 288 0 0-. 700 201.60
BROWN JERSEY GLOVE
Net Invoice 201.60
THANK YOU FOR YOUR ORDER ! !
Freight 18.54
Sales Tax 0.00
Invoice Total 220. 14
Less Deposit 0.00
220 .14
INVOICE BALANCE
VOUCHER NO. WARRANT NO.
ALLOWED 20
Halsen Products
IN SUM OF $
P. O. Box 877 i
Belmont, MS 38827 ti
$220.14
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
2201 1 0117860-IN I 43-560.011 $220.14 1 hereby certify that the attached invoice(s), or
1 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
� F 2013
Stri&Aegt jjAt 11�imwer
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))
02/28/13 0117860-IN $220.14
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