223114 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
ONE CIVIC SQUARE NORTHERN SAFETY CO, INC CHECK AMOUNT: $392.29
CARMEL, INDIANA 46032 PO Box 4250
o� UTICA NY 13504 CHECK NUMBER: 223114
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4239012 900522263 392 . 29 SAFETY SUPPLIES
AffORTHERN Remember...We Always Offer
• 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
;PLEASE REFER • • - . . • . . Carmel Clay Parks&Recreation
• • • • . INVOICE
4816021 Jim
1235 CENTRAL PARK DRIVE EAST
SOLD F CARMEL IN 46032-4421
TO: Carmel Clay Parks&Recreation
USA
1411 E 116TH STS o,� e
CARMEL IN 46032
USA JUL 2 9 2013
I 30096 07/24/2013
L� BY: ----- YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 08/23/2013
INVOICE NO./ORDER NO.
00522263/980169590 07/24/2013 FEDEX GROUND 07/24/2013 IF PAID BY 08/13/2013 PAY $ 384.84
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
11 11 26019 L PR MECHANIX UTIL GLV L 21.96 241.56
4 4 26019 XL PR MECHANIX UTIL GLV XTRA L 21.96 87.84
6 6 26521 EA ZTEK EYEWR CLR LENS S2510S 2.71 16.26
6 6 26523 EA ZTEK EYEWR GY LENS s2520s 3.12 18.72
3 3 21543 EA SPLASH GOGGLES 4401-400 2.75 8.25
Sae Sit HOW
ll2 -zM�9012
SALES TAX SHIPPING&HANDLING o . •
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 11/2%PER
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE
UNPAID BALANCE. $ 0.00 $ 19.66 S 392.29
Payments must be payable in US dollars only
"2%discount does not apply to credit card payments Thank You for" Your Order!
FEDERAL ID#16-1214814
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show-, kind d of service,
, price performed, dates service rendered, by
rate
whom, rates per day, number of hours, r
Payee Purchase Order No.
Terms
226500 Northern Safety Co., Inc.
P.O. Box 4250
Utica, NY 13504-4250
Invoice Invoice Description PO# Amount
Date Number (or note attached invoices) or bill(s)) 392.29
30096 $
7/24/13 900522263 Safety supplies
I -
I
Total $ 392.29
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
20_
Clerk-Treasurer
— _1
Voucher No. Warrant No.
226500 Northern Safety Co., Inc. Allowed 20
P.O. Box 4250
Utica, NY 13504-4250
In Sum of$
$ 392.29
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1093 900522263 4239012 $ 392.29 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
8-Aug 2013
Signature
$ 392.29 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund