HomeMy WebLinkAbout233806 06/18/14 CAA .
y'...,.wR. CITY OF CARMEL, INDIANA VENDOR: 366244
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ONE CIVIC SQUARE MEDASSURE CHECK AMOUNT: $*******200.00*
CARMEL, INDIANA 46032 1013 S GIRLS SCHOOL ROAD CHECK NUMBER: 233806
INDIANAPOLIS IN 46231 CHECK DATE: 06/18/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 171175 200.00 OTHER EXPENSES
.-----=-- _- _ MedAssure CUSTOMER NO
ME DA dw% 1013 S.Girls School Road
Indianapolis,IN 46231 000240
(317)635-8000 INVOICE DATE
�+a i.—UC:--N'',,'L—'iCif4-YRYOUR Mi-1—t WA,!l':t't:t.Af,,
11/30/2013
INVOICE NO
0000171175
=�WestMain
SERVICE ADDRESS:
Waste 901 N Range Line Rd
Carmel, IN 46032
TERMS DUE DATE SALES REP
SERVICE DATE Net 15 Days 12/15/2013
DESCRIPTION QUANTITY UNIT PRICE AMOUNT
001 -Carmel Household Hazardous-901 N Range Line Rd
11/22/13 31 Gallon Mixed Waste Per Container 8.00 25.00 200.00
CURRENT 30 DAYS 60 DAYS 90 DAYS OVER 90 DAYS
AMOUNT DUE $200.00
200.00 0.00 0.00 0.00 0.00
I
TEAR ON ABOVE PERFORATED LINE AND RETURN STUB WITH PAYMENT
BILL TO: CUSTOMER NO INVOICE DATE INVOICE NO INVOICE AMOUNT
Carmel Household Hazardous 000240 11/30/2013 0000171175 $200.00
40 West Main
Carmel,IN 46032 AMOUNT PAID CHECK NO
REMIT TO:
MedAssure
1013 S.Girls School Road
Indianapolis, IN 46231
Invoice#0000171175 Page 1 of 1
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
366244
MEDASSURE Purchase Order No.
1013 S GIRLS SCHOOL ROAD Terms
INDIANAPOLIS, IN 46231 Due Date 6/12/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/12/2014 171175 $200.00
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
G'//G v
/,y � P-" C� o
Date Officer
VOUCHER # 138235 WARRANT # ALLOWED
366244 IN SUM OF $
MEDASSURE
1013 S GIRLS SCHOOL ROAD
INDIANAPOLIS, IN 46231
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
171175 01-720H-08 $200.00
Voucher Total $200.00
Cost distribution ledger classification if
claim paid under vehicle highway fund