220726 06/04/2013 d CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
ONE CIVIC SQUARE NORTHERN SAFETY CO, INC
CHECK AMOUNT: $194.80
,? CARMEL, INDIANA 46032 PO BOX 4250
4, oN� UTICA NY 13504 CHECK NUMBER: 220726
CHECK DATE: 6/4/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1094 4239012 900410263 194 . 80 SAFETY SUPPLIES
Remember... We Always Offer Q�p
• Our Lowest Price When You Order. d PLEASE REMIT TO:
PO Box 4250 • Utica, NY 13504-4250 100%Satisfaction Guaranteed! NORTHERN SAFETY CO.,INC.
Phone: 800.631 .1246 a 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
•'' ' 4816021 Nicole
1235 CENTRAL PARK DRIVE EAST
SOLD I -Carmel Clay Parks&Recreation CARMEL IN 46032-4421
TO: 1411 E 116TH ST i USA
CARMEL IN 46032 L
USA MAY 0 6'2013
MC004066 05/02/2013
L Y, YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT-DUE BY 06/01/2013
—-INVOICE NO./ORDER.NO. _
00410263/980133804 05/02/2013 FEDEX GROUND 05/02/2013 IF PAID BY 05/22/2013 PAY $ 1 91.40
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
10 10 1290 BX SHEER STRIPS 1 X 3 1 OOBX 1290 033 3.87 38.70
12 12 2035 EA WATRPRF ADHES TAPE.5'X 5 YD 2035033 1.69 20.28
6 6 1728 EA HYDROGEN PEROXIDE 16 OZ BOT 1.39 8.34
12 12 19818 EA IRRIGATE EYE WASH 4 OZ BOT SNGL USE 2.95 35.40
5 5 7575 BX NON-ADHERA STERILE PAD 3"X 4"-100BX 10.85 54.25
5 5 30962 BX ALCOHOL PREP PAD M 2.56 12.80
Purchase
Dr scription 1
P.0.# �/yI�?'G/ z /0401 6p GQ/FV�
G.L.#
Bud. et
Line escr
Purchaser Date
Approval Date
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 11/2%PER SALES TAX SHIPPING&HANDLING
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE $ 0,00 $ 25.03 $ 194.80
UNPAID BALANCE.
Payments must be payable in US dollars only -
"2%discount does not apply to credit card payments Thank You for Your Order! I
4414
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
5/2/13 900410263 First aid supplies $ 194.80
Total $ 194.80
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$
$ 194.80
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1094 900410263 4239012 $ 194.80 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
30-May 2013
Signature
$ 194.80 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund