HomeMy WebLinkAbout229054 2/11/2014 CITY OF CARMEL, INDIANA VENDOR: 146900 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL MCAT ECK AMOUNT: $100.00
CARMEL, INDIANA 46032 CASHIER OFFICE-MAIL CODE 50-10C H
100 N SENATE AVE CHECK NUMBER: 229054
INDIANAPOLIS IN 46204
CHECK DATE: 2/11/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4358300 183689 100 . 00 OTHER FEES & LICENSES
INVOICE
Please Remit To: Page: 1
INDIANA DEPT OF ENVIRONMENTAL MGMT Invoice No: 000183689
CASHIER OFFICE-MAIL CODE 50-10C a 7 Invoice Date: 01/10/2014
100 NORTH SENATE AVENUE Customer Number: CST100026885
INDIANAPOLIS IN 46204 JAN 1 2014 Bill Type: 062
Payment Terms: NET 60
Due Date: 03/11/2014
Bill To: --
CARMEL CLAY PARKS&RECREATION
MS AUDREY KOSTRZEWA-FLOWING WELL AMOUNT DUE: 100.00 USD
1411 EAST 116TH STREET
CARMEL IN 46032
� loo . 00
Amount Remitted
Note Address Changes Above
For billing uestions, please call 317-232-8705
Line Adj Identifier Description — Quantity UOM Unit Amt Net Amount
1 14=IN2290801T-0 PWS Fee - GW 1.00 EA 100.00 100.00
- IDEM's Cashier office is now accepting payment by Master Card or Visa between the hours of 9 am to
3 pm Monday through Friday. You may come to the office or call (317) 232-8705. A processing fee of
$1 plus 21 will be charged of the total transaction.
- This annual fee billing is required for active Public Water Systems (to defray the costs of
administering activities of the federal Safe Drinking Water Act) under Indiana Code: IC 13-18-20.5.
° To view via the internet, visit:
g http://www.IN.gov/legislative/ic/code/Litlel3/arl8/ch2O.5.html
Fees are based on the activity status as of December 31 of the previous year.
Fees on Transient Non-Community Water System will be based on the type of water system on record
by December 31 of the prior year.
- Fees are not pro-rated. If a system is sold or inactivated during the billing year, the amount of
the assessed fee remains due and payable.
- If payment of the assessed fee amount imposes an undue burden on the public water system, the
facility may notify this Agency within forty-five _(45) days of this invoice date to pay in four
equal installments within a year.
- Payments not received or received after the DUE date are subject to a delinquency charge equal to
10% of the assessed fee. The complete fee payment or the lst installment is due within 60 days of
the date of this invoice.
- If several invoices are to be paid by one check, you MUST INCLUDE A COPY OF EACH BILLING INVOICE
in order to ensure proper credit for each fee assessment.
- For questions regarding your assessed fee amount, please contact Deborah Glover in the Office of
Water Quality at (317) 232-8472 or e-mail dglover@idem.in.gov.
-IDEM may pursue enforcement action for non payment of annual fees.
TOTAL AMOUNT DUE: 100.00
A copy of your invoice must be included with payment. Flow VI�(, WelJ st�'fc_8
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495-IDEM Printed on Recycled Paper Original
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.
146900 Indiana Department of Environmental Mgmt Terms
Cashier Office - Mail Code 50-10C
100 North Senate Ave
Indianapolis, IN 46204-2251
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
1/10/14 183689 Flowing Well Safe drinking water act fee xx152 $ 100.00
I
_F
Total $ 100.00
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
120
Clerk-Treasurer
Voucher No. Warrant No.
146900 Indiana Department of Environmental Mgmt Allowed 20
Cashier Office - Mail Code 50-10C
100 North Senate Ave
Indianapolis, IN 46204-2251 In Sum of$
$ 100.00
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITLE AMOUNT
1125 183689 4358300 $ 100.00 1 hereby certify that the attached invoice(s), or
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
6-Feb 2014
Signature
Is 100.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund