218235 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 363840 Page 1 of 1
ONE CIVIC SQUARE STATE SAFETY&COMPLIANCE LLC
CARMEL, INDIANA 46032 5338 VICTORY DRIVE STE A CHECK AMOUNT: $479.49
? INDIANAPOLIS IN 46203
CHECK NUMBER: 218235
CHECK DATE: 3/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 10002131 70 . 79 OTHER EXPENSES
651 5023990 10002961 219 . 29 OTHER EXPENSES
651 5023990 10003548 63 . 66 OTHER EXPENSES
651 5023990 10005856 64 . 70 OTHER EXPENSES
651 5023990 10006128 61 . 05 OTHER EXPENSES
INVOICE
State Safety & Compliance, LLC.
INVOICE
Branch: 701 Indianapolis 10003548
5338 Victory Dr Invoice Date Page
Suite A 2/21/2013 14:57:19 1 of I
Indianapolis, IN 46203 ORDER NUMBER
3682583
317-423-7724
Bill To: Ship To:
Carmel Waste Water Treatment Carmel Waste Water Treatment
Attn: Paul Arnone Attn: Blaine Mallaber(PO S13470)
9609 Hazel Dell Parkway 9609 Hazel Dell Parkway
Indianapolis,IN 46280 Indianapolis, In 46280
— Custouner-][D 109095- _
PO Number Terms Description Net Due Date Disc Due Date Discount Amount
S13470 0.5% 10 net 30 03/23/13 03/03/13 0.26
Order Date Pick Ticket No Primate Salesrep Name Taker
2/18/2013 13:37:03 6009484 Gary Smith JCHANEY
Quantities Pricing
Item ID UOM Unit Extended
Ordered Skipped Remaining U0111 y Item Description Unit Size Price Price
Unit Size 1 O
Delivery Instructions: UPS GROUND PREPAY&ADD
Carrier: UPS Ground-PPA Tracking#:IZ203YOA0355267892
6.0000 6.0000 0.0000 EA RIV2003-L EA 8.5700 51.42
1.0 RAINSUIT CLASSIC.35MM 3 PIECE PVC 1
JACKET W/ DETACHABLE HOOD & BIB
PANTS
Total Lines:1 SUB-TOTAL: 51.42
Total Freight In:0.00 Total Freight Out:12.24 TOTAL FREIGHT. 12.24
TAX: 0.00
AMOUNT DUE: 63.66
1
ORIGINAL
INVOICE
State Safety & Compliance, LLC.
INVOICE
Branch: 701 Indianapolis 10002961
5338 Victory Dr Invoice Date Page
Suite A 2/20/2013 16:07:43 1 of I
Indianapolis, IN 46203 ORDER NUMBER
3682583
317-423-7724
Bill To: Ship To: **DIRECT SHIPMENT**
Carmel Waste Water Treatment Carmel Waste Water Treatment
Attn: Paul Arnone Attn: Blaine Mallaber(PO S13470)
9609 Hazel Dell Parkway 9609 Hazel Dell Parkway
Indianapolis, IN 46280 Indianapolis, In 46280
— -Customer- ID: 109095
PO Number Terms Description Net Due Date Disc Due Date Discount Amount
S13470 0.5% 10 net 30 03/22/13 03/02/13 1.04
Order Date Pick Ticket No Primary Salesrep Name Taker
2/18/2013 13:37:03 6009135 Gary Smith JCHANEY
Quantities Pricing
/tern ID UOAf Unit Extended
UOA1 /tem Description Price Price
Ordered Stripped Benraiaing Unit Size
�.. _ Unit Size O --
Delivery Instructions: UPS GROUND PREPAY&ADD
Carrier: UPS Ground-PPA Tracking#:IZ4782120349122582
1.0000 1.0000 0.0000 DZ WCHV0500-L DZ 47.5000 47.50
1.0 GLOVES HI-VIZ COWHIDE PREMIUM 6DZ/CS 1
RUBBERIZED SAFETY CUFF; 2 STRIPES OF
REFLECTIVE TAPE...WING THUMB
1.0000 1.0000 0.0000 DZ WCHV0990K-L DZ 85.0000 85.00
1.0 GLOVES HI-VIZ LEATHER DRIVER IODZ/CS 1
2.1" REFLECTIVE SRIPE W/ A 3/4" GREEN
BAND IN THE MIDDLE...KEYSTONE THUMB
2.0000 2.0000 0.0000 DZ WC500-EAF DZ 37.9200 75.84
1.0 GLOVES LEATHER PALM FLEECE LND 2.5 CUFF 1
6DZ/CS
Total Lines:3 SUB-TOTAL: 208.34
Total Freight 1n:0.00 Total Freight Out:10.95 TOTAL FREIGHT: 10.95
___...._. _TAX. 0.00
AMOUNT DUE: 219.29
e Y �
ORIGINAL
INVOICE
State Safety & Compliance, LLC.
INVOICE
Branch: 701 Indianapolis 10005856
5338 Victory Dr Invoice Date Page
Suite A 2/28/2013 08:35:51 1 of 1
Indianapolis, IN 46203 ORDER NUMBER
3682583
317-423-7724
Bill To: Ship To: **DIRECT SHIPMENT**
Carmel Waste Water Treatment Carmel Waste Water Treatment
Attn: Paul Arnone Attn: Blaine Mallaber(PO S13470)
9609 Hazel Dell Parkway 9609 Hazel Dell Parkway
Indianapolis,IN 46280 Indianapolis, In 46280
Customer ID: 109095
PO Number Terms Description Net Due Date Disc Due Date Discount Amount
S13470 0.5% 10 net 30 03/30/13 03/10/13 0.25
Order Date Pick Ticket No Primary Salesrep Name Taker
2/18/2013 13:37:03 6011936 Gary Smith JCHANEY
Quantities Pricing
Ilea. ID U011I Unit Extended
Ordered Stripped Remaining UOM cC Item Description Unit Size Price Price
Unit Size O
Delivery Instructions: UPS GROUND PREPAY&ADD
Carrier: UPS Ground- PPA Tracking#:1 Z09X9240376360901
1.0000 1.0000 0.0000 EA OCC-LUX-TJBJ-XL EA 50.5900 50.59
1.0 JACKET BOMBER YLW CL 3; RFLTV STRIPES 1
Total Lines:1 SUB-TOTAL: 50.59
Total Freight In:0.00 Total Freight Out:14.11 TOTAL FREIGHT. 14.11
TAX: 0.00
A1lI0UNT DUE: 64.70
ORIGINAL
INVOICE
State Safety & Compliance, LLC. INVOICE
Branch: 701 Indianapolis 10002131
5338 Victory Dr Invoice Date Page
Suite A 2/18/2013 15:29:40 1 of 1
Indianapolis, IN 46203 ORDER NUMBER
3682583
317-423-7724
Bill To: Ship To:
Carmel Waste Water Treatment Carmel Waste Water Treatment
Attn: Paul Arnone Attn: Blaine Mallaber(PO S13470)
9609 Hazel Dell Parkway 9609 Hazel Dell Parkway
Indianapolis,IN 46280 Indianapolis, In 46280
Cu:;tomncr T.D: 109095 - -
PO Number Terms Description Net Due Date Disc Due Date Discount Amount
S13470 0.5% 10 net 30 03/20/13 02/28/13 0.30
Order Date Pick Ticket No Primary Salesrep Name Taker
2/18/2013 13:37:03 6008134 Gary Smith JCHANEY
Quantities Pricing
Item ID U0111 Unit Extended
c Item Description Price Price
Ordered Shipped Remaining UOM Unit Size
Unit Size O
Delivery Instructions: UPS GROUND PREPAY&ADD
Carrier: UPS Ground-PPA Tracking#:IZ203YOA0353126814
2.0000 2.0000 0.0000 DZ SG1345-L DZ 30.0000 60.00
12.0 GLOVES LEATHER RR 2.5 CUFF 6 DZ/CS 12
3/4 LEATHER BACK STRIPE FABRIC BACK
2.5" RUBBERIZED CUFF LINED PALM (6
DZ/CASE)
Total Lines:I SUB-TOTAL: 60.00
Total Freigh1In:0.00 Total Freight Out:10,79 TOTAL FhFIGuT, 10.79
TAX. 0.00
AMOUNT DUE: 70.79
ORIGINAL
INVOICE
State Safety & Compliance, LLC. INVOICE
Branch: 701 Indianapolis 10006128
5338 Victory Dr Invoice Date Page
Suite A 2/28/2013 14:21:47 1 of 1
Indianapolis, IN 46203 ORDER NUMBER
3682583
317-423-7724
Bill To: Ship To:
Carmel Waste Water Treatment Carmel Waste Water Treatment
Attn: Paul Arnone Attn: Blaine Mallaber(PO S13470)
9609 Hazel Dell Parkway 9609 Hazel Dell Parkway
Indianapolis, IN 46280 Indianapolis, In 46280
Customer ID: 109095
PO Number Terms Description Net Due Date Disc Due Date Discount Amount
S13470 0.5% 10 net 30 03/30/13 03/10/13 0.26
Order Date Pick Ticket No Primary Salesrep Name Taker
2/18/2013 13:37:03 6012102 Gary Smith JCHANEY
Quantities Pricing
/tent ID UOM Unit Extended
Ordered Skipped Remaining UOM d Item Description Unit Size Price Price
Unit Size O
Delivery Instructions: UPS GROUND PREPAY&ADD
Carrier UPS Ground- PPA Tracking#:1Z203YOA0354757686
24.0000 24.0000 0.0000 EA PYS2570S EA 2.2000 52.80
1.0 GLASSES SILVER MIRROR LNS/FRM ZTEK 12/13X 1
Total Lines:I SUB-TOTAL: 52.80
Total Freiglit In:0.00 Total Freight 0w:8,25 TOTAL FREIGHT: 8.25
TAX: 0.00
A JOUATT n»F: 61.05
ORIGINAL
VOUCHER # 135027 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
10002961 01-7202-06 4 $219.29
r1100 535b of--290 -0t'
or-7aoq-0b
(03.. ok
oS
q-77j99
Voucher Total
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 3/6/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/6/2013 10002961 $219.29
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
Date Officer