224061 09/10/2013 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
ONE CIVIC SQUARE NORTHERN SAFETY CO, INC
CHECK AMOUNT: $306.69
CARMEL, INDIANA 46032 Po BOX 4zso
_off�a UTICA NY 13504 CHECK NUMBER: 224061
CHECK DATE: 9/1012013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 900558654 306 . 69 OTHER EXPENSES
NORTHERN Remember..We Always Offer INVOIct
• 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 TO YOUR.CUSTOMER . . . . Carmel Water Distribution
ORDER N..,IN ALL,COMMUNICATIONS REGARDING THIS INVOICE
3217619 Tim
4915 E 106th St
SOLD CARMEL IN 46033-3800
TO: Carmel Water Distribution
USA
3450 W 131 st St
CARMEL IN 46074-8267
USA
KR73013 08/20/2013
YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE NO./ORDER NO. INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 09/19/2013
00558654/100317577 08/20/2013 FEDEX GROUND 08/20/2013 IF PAID BY 09/09/2013 PAY $ 301.18
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
14 14 3154 EA EYESALINE EYE WASH 16 OZ REFILL BOT 8.41 117.74
4 4 4471 EA SPARKPLUGS PLUG STATION DISPEN 250 PR 39.45 157.80
1 1 32379 F EA BACKYARD BARBECUE KIT PROMO ITEM 0.00 0.00
1.001 1 BC132 EA 2013 CATALOG KIT 0.00 0.00
V1
SALES TAX SHIPPING&HANDLING
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 1'/,%PER
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE $ x•00 $ 31.15 $ 306.69
UNPAID BALANCE. - - _ -
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
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
226500
NORTHERN SAFETY CO, INC Purchase Order No.
PO BOX 4250 Terms
UTICA, NY 13504 Due Date 8/30/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/30/2013 900558654 $306.69
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
VOUCHER # 132630 WARRANT # ALLOWED
226500
( IN SUM OF $
NORTHERN SAFETY CO, INC
PO BOX 4250
UTICA, NY 13504
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
i
PO# INV# ACCT# AMOUNT I Audit Trail Code
900558654 01-6200-03 $306.69
Voucher Total $306.69
Cost distribution ledger classification if
claim paid under vehicle highway fund