223577 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 205250 Page 1 of 1
ONE CIVIC SQUARE MINE SAFETY APPLIANCES CO
CARMEL, INDIANA 46032 PO Box 426
CHECK AMOUNT: $941.40
PITTSBURGH PA 15230-0426
CHECK NUMBER: 223577
CHECK DATE: 8/27/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 97055819 941 . 40 OTHER EXPENSES
A Invoice
The Safety Company
Mine Safety Appliances Company
PO Box 426
Pittsburgh, PA 15230-0426
D-U-N-S 00-432-1865
FEI 25-0668780
29141767'44022'U5n5_C'1375569252'0384'R10 112 Invoice No.: 97055819
CITY OF CARMEL Invoice Date: 02 Jul 2013
WASTEWATER TREATMENT PLANT Customer No.: 648647
ATTN:BLAINE MALLABER Order No.: 4399801
9609 HAZEL DELL PARKWAY Delivery No.: 88426577
INDIANAPOLIS IN 46280 P.O. Date: 28 Jun 2013 =_
P.O. No.: S13628 =
- - - ----- - - --- - Ship To: - - - - - - -
CITY OF CARMEL
WASTE WATER TREATMENT PLANT
ATTN:BLAINE MALLABER
9609 HAZEL DELL PARKWAY
INDIANAPOLIS IN 46280
Your Contact Person: Customer Service
Telephone No.: 800-672-46780000 Fax No.: 724-776-3280 PAGE 1 - 2
Date Shipped Shipped via Bill of lading No. Terms of Shipment Terms of Payment
02 Jul 2013 UPS Ground FOB SP/PPD/A NET 30 DAYS
Item Qty UM Mat No. Description % Unit Price Net Price
EFTA Batch Qty
10 2 EA A-ULTX-SENS 465.00 930.00
SENSOR, ULTIMA X, CONFIGURED
Country of Origin: US Commodity Code: 9027.10.2000
Export Control Class: 1A995
Dangerous Goods ID Number: UN2800
--_--A--ULTX-SENS:-16-1-0 - -- - - - — - - -- --With the following configuration:
GAS TYPE SENSOR 16 H2S -0-50 ppm
ENCLOSURE TYPE 1 STAINLESS STEEL, XP OR GP,
CUSTOM FEATURES 0 NONE
The Safety Company
Invoice —
Invoice No.: 97055819 Customer P.O. No.: S13628
PAGE 2 - 2
Item Qty UM Mat No. Description % Unit Price Net Price
EFTA Batch Qty
Shipping Info:
UPS Ground
1Z1881500358048845
....................................................................................................................................
Remit Payment to: SubTotal: 930.00
Mine Safety Appliances Co.
P.O.Box 640348 Shipping&Handling: 11.40
Pittsburgh,PA.15264-0348
Fax:412-967-3087 Total USD: 941.40
THERE IS A SERVICE CHARGE OF
1.25%ON ALL ITEMS PAST DUE
THANK YOU FOR YOUR ORDER
VOUCHER # 136193 WARRANT # ALLOWED
367226 IN SUM OF $
Mine Safety Appliances
PO BOX 426
PITTSBURGH, PA 15230-0426
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
97055819 01-7202-06 $941.40
Voucher Total $941.40
Cost distribution ledger classification if
claim paid under vehicle highway fund
i
a
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
367226
Mine Safety Appliances Purchase Order No.
PO BOX 426 Terms
PITTSBURGH, PA 15230-0426 Due Date 8/20/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/20/2013 97055819 $941.40
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
�/LL1j3 ��c t�l
Date Officer