224282 09/23/2013 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
ONE CIVIC SQUARE NORTHERN SAFETY CO, INC
CARMEL, INDIANA 46032 PO BOX 4250
CHECK AMOUNT: $278.59
UTICA NY 13504
CHECK NUMBER: 224282
CHECK DATE: 9/23/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 900575957 124 . 98 GENERAL PROGRAM SUPPL
1081 4239039 900589409 153 . 61 GENERAL PROGRAM SUPPL
Of Remember...We Always Offer
• Our Lowest Price When You Order. PLEASE REMIT To:
PO Box 4250 • Utica, NY 13504-4250 100%Satisfaction Guaranteed! WNORTHERN SAFETY CO.,INC.
Phone: 800.631.1246 o 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 Jennifer
3495 W. 126th Street
SOLD ��CEIVED USA
IN 46032-9557
TO: Carmel Clay Parks&Recreation
1 4 1 1 E 116TH ST n
CARMEL IN 46032 SEP 0 9 2013
USA
��. E0003711 09/03/2013
L YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 10/03/2013
INVOICE NO./ORDER NO.
00575957/980186399 T 09/03/2013 FEDEX GROUND 09/03/2013 IF PAID BY 09/23/2013 PAY $ 122.80
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
5 5 31964 BX NS STING RELIEF WIPES 10/BX 2.00 10.00
2 2 4726 BX BURN JEL UNIT DOSE DISPEN BX OF 25 21.04 42.08
5 5 1075 BX PLSTC STRIPS 3/4 X 3 100BX 1075033 3.49 17.45
1 1 4646 BX HYDROCORTISONE CREAM 1% 144/BX 18.75 18.75
2 2 30918 BX BZK ANTISEPTIC WIPES 100BX 1303 2.95 5.90
5 5 31962 BX NS TRIPLE ANTIBOITIC CREAM 20/BX 2.00 10.00
1 1 1070 BX EX.LG PLSTC STRIPS 2 X 4 1/2 1070033 4.65 4.65
I D�1-10-�2�039
SALES TAX SHIPPING&HANDLING • •
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 02%PER
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE $ 0.00 $ 16:15 $ 124.98
UNPAID BALANCE. _
Payments must be payable in US dollars only
ORTHERNRemember...We Always Offer
IlN • 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
• • • Carmel Clay Parks&Recreation
e•. a -.
4816021 Nikesha
4311 E. 116th Street
SOLD s: t 5�q 6 '� CARMEL IN 46033-3353
TO: Carmel Clay Parks&Recreation r-" ,` � , sD USA
1411 E 116TH ST
CARMEL IN 46032 L1, S P 16 2013
USA E0003732 09/12/2013
L YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED
INVOICE NO./ORDER NO. PAYMENT DUE BY 10/12/2013
00589409/980190632 09/12/2013 FEDEX GROUND 09/12/2013 IF PAID BY 10/02/2013 PAY $ 1 51.1 3
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
6 6 30918 BX BZK ANTISEPTIC WIPES 100BX 1303 2.80 16.80
1 1 4426 CS FACIAL TISSUE 30CS WIN 2360 33.23 33.23
4 4 8589 L BX FLEXSHIELD POWD FREE GLV 5 MIL L PFNT95 11.75 47.00
1 1 24847 PK SKIN PROTEC STINGX TOWELETTES 25PK 4.69 4.69
1 1 32492 EA EYE DROPS 3.43 3.43
1 1 4646 BX HYDROCORTISONE CREAM 1% 144/BX 18.75 18.75
e a
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
UNPAID BALANCE. $ 0.00 $ 29.71 $ 1.53.61
--payments-must-be-payable in US-dollars-only ` r
"2%discount does not apply to credit card payments Than e you Tole Your Order
rGnCDAI InN 1R_i DIAPIA
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
9/3/13 900575957 Supplies $ 124.98
9/12/13 900589409 Supplies 153.61
Total $ 278.59
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$
$ 278.59
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or Board Members
Dept#
INVOICE NO. ACCT#/TITLE AMOUNT
1081-10 900575957 4239039 $ 124.98 1 hereby certify that the attached invoice(s), or
1081-11 900589409 4239039 $ 153.61 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
19-Sep 2013
Signature
$ 278.59 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund