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Home My WebLink About233773 06/18/14 CITY OF CARMEL, INDIANA VENDOR: 146900 ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL Mme,1ECK AMOUNT: $......**30.00* CARMEL, INDIANA 46032 CASHIER OFFICE-MAIL CODE 50-10C CHECK NUMBER: 233773 9M�TON�o. 100 N SENATE AVE CHECK DATE: 06/18/14 INDIANAPOLIS IN 46204 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 6635462-C 30.00 OTHER EXPENSES IDEM Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number: 6635462 Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt 4 (Office Only) May 19,2014 Certificate Number: DS120079 Matthew D.McNulty Expiration Date: 06/30/2014 10730 N.Park Ave. Grade: DSL Indianapolis IN 46280 Obtained By: Examination Login ID: DS120079 Password: 1279629 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. DS 120079, Grade DSL for a class DSL Water Distribution System expires on 06/30/2014. You are required to obtain 15.00 contact hours of continuing education for renewal. Our records indicate that you currently have accumulated 47.00 contact hours 0 towards renewal. (This may not reflect hours for courses recently attended.) 0 Note: If you have not recently attended an approved course, and you do not have the required number of hours, you need to attend courses prior to July 1, 2014. After this date you-are on expired status and are not a valid certified operator. You do have until July 1, 2015 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2015 will result in termination of your certification, and you will have to retest. Online Renewal—Online renewal is available 24 hours a day, 7 days a week at httt)s://mylicense.in.gov. The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal. The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID and Password are listed above. Mail Renewal—To renew through the mail,please fill out the section on the back of this page and return this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take longer than an online renewal. If you have other drinking water certifications due renewal, you can combine them in one mailing with a fee payment that covers all of them. For example: (3 renewals x $30/per renewal)_ $90 combined fee. Remit Payment to: Indiana Department of Environmental Management Cashier's Office—Mail Code 50-1 OC 100 N. Senate Avenue Indianapolis, IN 46204-2251 SEE FORM ON OTHER SIDE ' (I) Cancel Certification-If you do not want to renew,this certification, please write"CANCEL" on this form, sign and date in spaces provided, and mail to the remittance address listed. FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING If this certification was obtained by Examination-and the facility you are employed at has changed,please add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site Specific, it is valid only for the location below. Operator Number: DS 120079 Invoice Number: 6635462 PWS Name PWS ID Carmel Water Department 15229004 Address Change: Home Phone Number: Work Phone Number: Operator Signature: ` Date: G �� --- - - - - _ (2) - VOUCHER # 135294 WARRANT# ALLOWED TIDEM IN SUM OF $ IDEM 100 N SENATE AVENUE INDIANAPOLIS, IN 46204-2251 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV* ACCT# AMOUNT Audit Trail Code 663413 01-6040-05 $30.00 Voucher Total D Cost distribution ledger classification if claim paid under vehicle highway fund 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 TIDEM IDEM Purchase Order No. 100 N SENATE AVENUE Terms INDIANAPOLIS, IN 46204-2251 Due Date 6/6/2014 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 6/6/2014 663413 $30.00 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 //y Date Officer