226413 11/19/2013 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
"F ONE CIVIC SQUARE NORTHERN SAFETY CO,INC CHECK AMOUNT: $99.36
o CARMEL, INDIANA 46032 Po Box 4250
UTICA NY 13504 CHECK NUMBER: 226413
CHECK DATE: 11/19/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 900651309 99 . 36 OTHER EXPENSES
NORTHERN Remember... We Always Offer
7-m- NEWIT-7mmm 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 Water Distribution
3217619 Jerry
4915 E 106th St
SOLD F— CARMEL IN 46033-3800
TO: Carmel Water Distribution
USA
3450 W 131 st St
CARMEL IN 46074-8267
USA
JC 1030 10/30/2013
L YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 11/29/2013
` INVOICE NO./ORDER NO.
900651309/100369924 10/30/2013 FEDEX GROUND 10/30/2013 IF PAID BY 11/19/2013 PAY $ 97.66
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
1 1 5754 FD PK EMPTY CLYDR DO NOT USE(BH SIDES) FLXCRD 25.33 25.33
1 1 5756 FD PK FULL CYYDR RDY FOR USE(BH SIDES) FLXCRD 25.33 25.33
12 12 32332 EA NS RIVAL GT EYEWEAR GRAY LENS 2.87 34.44
1.001 1 BC132 EA 2013 CATALOG KIT 0.00 0.00
SALES TAX SHIPPING&HANDLING •
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 1112%PER
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE -$ Q_ _ _.
UNPAID BALANCE. - .-__ _: _—_,- - ----Q� $ 14.26 $ 99.36--
Payments must be payable in US dollars only
"2%discount does not apply to credit card payments Thank You for Your Orders
I
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 11/7/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/7/2013 900651309 $99.36
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 # 133296 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
PO# INV# ACCT# AMOUNT Audit Trail Code
900651309 01-6200-03 $99.36
Voucher Total $99.36
Cost distribution ledger classification if
claim paid under vehicle highway fund