37163 Northern Safety ,.--. INDIANA RETAIL TAX EXEMPT PAGE 1
•(/�1,y / ^� CERTIFICATE NO. 003120155 002 0 -__ __ _
7 t�`• o _ (2ar11 ie _- -----_ --- - __ ...__ _____ PURCHASE OI2DFH NUMBER-
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V .l. 1 \ 11111 1 \ 111 _ ._ _____..._.
FEDERAL EXCISE TAX EXEMPT 37163
35-60000972
lids NUMIII H MUSI APPEAR ON INVOICE S.RIP
VOUOIIPH,OH IVEHY Mr MO.PACKING SI IPS.
SI UPPING I AB1 15 AND ANY CORHI SPUMEUD NCI
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PUHCI IASE O 2D E I2 DAT E p.AT F REQU I 2FD REQUISITION No.
VENDOR NO DESCRIPTION
6/10/2014 05/05/14 1339 Safety Supplies
. - _ . . - . . .
Northern Safety Co. Inc. Parks Maintenance
P.O. Box 4250 1427 E. 116th Street ATTN: Courtney
VENDOR Utica, NY 13504-4250 SHIP Carmel, IN 46032
TO
_
CONI IHMA!ION IIAOKI-1 1 CON I PAC I PA°MPNI IHEM.S PREICHI
MAN SC RIPTIOM1' - I UNn I RICE EXTENSION
AN IITV UNIT 01 MFA OF
-_.. _ ..__.._
1.000 each 22851 - Breakaway cotton neck cords for glasses - 12pk $ 2.87 $ 2.87
5.000 each 21543- N-Specs Safety Eyewear Antifog goggles $2.75 $ 13.75
6.000 each 4534 - 12oz Tecnu poison ivy wash $ 10.55 $ 63.30
2.000 each 23259- Medium Safety Vest in Orange $ 13.99 $27.98
2.000 package 20095 - 7000 Dust mask 50pk $ 9.45 $ 18.90
4.000 each 7019- Allegro respirator storage bag $4.42 $ 17.68
4.000 each 7700 series silicone 1/2 mask respirator $ 28.08 $ 112.32
4.000 package 3951 - North acid gases respirator 2 pk $ 12.58 $ 50.32
4.000 package 3959 - P100 Particulate respirator cartridge 2 pk $ 9.01 $ 36.04
4.000 package 3884 - North defender multi gas/vapors/P100 respirator $ 23.98 $ 95.92
cartridge 2pk
1.000 package Shipping $ 26.99 $ 26.99
GLAccountt/ 1125401-4239012
•
Send Invoice To•
$466.07
PLEASE INVOICE IN DUPLICATE
111 I'AHIIdINI ACCOUNT I __ _ P @OJILI I_ +HOJI'CI ACCO'JNI gIdOUNI
i 125—" IF 23Q0/2 PAYMENT
• AM,VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.NUMBER IS MADE A
PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
SHIPPING INSTRUCTIONS AFFIDAVIT ATTACHED.
. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATEO BALANCE IN THIS APPROPRIATION
• SI HP HI PAID SUFFICIENT TO PAY FOR THE ABOVE ORDER.
. C0.11 SIUPMIiN I S CANNOT BL ACCIP II D.
PURCImsF OPITHNUM111 R MUST APPI AR ON Al 1 SHIPPING I AIMI A ORDERED BY Courtney Schlaegel ' V-"�.- i
•
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• 1115 Ad I{t ISSUE IDIC 1111 TANG-WTI IICIIAP II NI 1111 I50 IN
AND AC s nMl Nun as n n erol AM)SUPPI I nn NI n n HI !G TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 37163