218568 03/25/2013 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
ONE CIVIC SQUARE NORTHERN SAFETY CO, INC CHECK AMOUNT: $77.48
CARMEL, INDIANA 46032 PO BOX 4250
UTICA NY 13504 CHECK NUMBER: 218568
CHECK DATE: 3/25/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 90033719 77 . 48 GENERAL PROGRAM SUPPL
®RTHERN Remember...We Always Offer INVOICE
ff • Our Lowest Price When You Order. PLEASE REMIT TO:
PO Box 4250 • Utica, NY 13504-A250 100%Satisfaction Guaranteed! NORTHERN SAFETY CO.,INC.
Phone: 800.631 .1246 e Fax: 800.635.1591 P.O. Box 4250
northernsafety.com
Utica, NY 13504-4250
SHIP TO(IF OTHER THAN"SOLD TO")
YOUR CUSTOMER ID
- o e - = • Carmel Clay Parks&Recreation
4816021 ESE
10850 Towne Road
SOLD CARMEL IN 46032-8912
TO: Carmel Clay Parks&Recreation
���`�'�'T1, USA
1411E 116TH ST J`�-"--° �--� � -' �D
CARMEL IN 46032 MAR 1 1 2013
USA
�.�y E0003186 03/07/2013
L J J__ YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 04/06/2013
INVOICE NO./ORDER NO.
900337719/980110127 03/07/2013 FEDEX GROUND 03/07/2013 IF PAID BY 03/27/2013 PAY $ 76.21
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
8 8 31039 BX BAND AID SHEER STRIPS ASSORTED PK/80 4.11 32.88
6 6 31962 BX NS TRIPLE ANTIBOITIC CREAM 20/BX 2.00 12.00
1 1 4646 BX HYDROCORTISONE CREAM 1% 144/BX 18.75 18.75
Purchase ADescription �.�`�//►►-�� ��
91 P.O.# f- �(or P or F
G.L.#_1081.9•
Budget
Line Descr
—_--
Purchaser D Date
Approval Date
SALES TAX SHIPPING&HANDLING •
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF Mel.PER
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE
UNPAID BALANCE _.___:_ ,--.___ $ 0.00 _ _„S_ 13.85 __$__ 77.48 __.
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
3/7/13 90033719 Supplies $ 77.48
Total $ 77.48
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
Voucher No. Warrant No.
226500 Northern Safety Co., Inc. Allowed 20
P.O. Box 4250
Utica, NY 13504-4250
In Sum of$
$ 77.48
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-9 90033719 4239039 $ 77.48 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
21-Mar 2013
Signature
$ 77.48 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund