HomeMy WebLinkAbout239709 12/03/2014 ,CAq
CITY OF CARMEL, INDIANA VENDOR: 362497
ONE CIVIC SQUARE DEPT HOMELAND SECURITY CHECK AMOUNT: $*******360.00*
4 ,q CARMEL, INDIANA 46032 302 W WASHINGTON CHECK NUMBER: 239709
9a,,�TON. RM E221 CHECK DATE: 12/03/14
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1208 4350900 10242014-1 360.00 OTHER CONT SERVICES
ELEVATOR OPERATING CERTIFICATE INVOICE
C ARMEL REDEVELOPMENT COMMISSION 30 WEST MAIN STREET SUITE 200 CARMEL IN 46032
1.If Code = An annual test report is due before a permit is issued.
2.If Code = # A 5 year Test report is due before a permit is issued.
3.Over due fees must be paid before a permit is issued.
If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE
AFFIRMATION" form.
State No.Code Due Over Due Location Address
113739 * $120.00 $ 0.00 ONE CENTER GREEN, CARMEL IN 46032
* 20.00 ONE CENTER GREEN CARMEL IN 46032 ��
1 0.00 ,
113740 S S
113742 * $120.00 $ o.00 ONE CENTER GREEN, CARMEL IN 46032
I ,
Submit;
ed To
' DEC 0 1 2014
1 Clerk Treasurer
l Please submit ENTIRE document with payment
D
Reference N voice ate
771652-10242014 -1 10/24/2014 Unit(s) 3 Total Due upon receipt
of 3 $ 360.00 of $ 360.00
i -
I _.
Owner Id 771652
Ref.Num. :771652-10242014 -1 $360 of $ 360.00 Invoice Date 10/24/2014
{ If Paying by check, include a'check made payable to the Department of Homeland security.. You can pay all your
payments online at IDHS web site https://myor4cle.in.gov/dfbs/idhsFeesFines/start.do with-Visa/Master
i
Card/Discover cards. Use Owner Id on this letter or State Number on the invoice to pull up information when
paying the dues online.OR complete the following information and return by mail :Indiana Department of
Homeland Security, Fiscal Department, 302 W.Washington St., Rm : E221,Indianapolis, IN 46204 or fax to
(317)233-0401. Questions? call(317)232-6427 or E-mail:elevator-invoice@dhs.in.gov 2.25% convenience fee
! charged on all credit card payments.
I
Full Name on Credit Card
Billing Address: Street
` City State Zip Code
} CC type:Visa/Am.Express/Discover/Master Card ONLY (circle one)
Acct. Number Exp.Date (mm/yy)
CVV2 Number Contact Phone Number Signature
I By signing, cardmember agrees to the obligations set forth by the Cardmember's
Agreement with the issuer.
1
I Invoice Date 10/24/2014
! Ref.Num. :771652-10242014 -1 $360 of $ 360.00
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VOUCHER NO. WARRANT NO.
Department of Homeland Security ALLOWED 20
Indiana Dept of Homeland Security, Fiscal Dept IN SUM OF$
302 W Washington St., Rm E221
Indianapolis, IN 46204
$480.00
ON ACCOUNT OF APPROPRIATION FOR
Building Operations Account
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1208 71652-10242014 -509.00 $360.00 I hereby certify that the attached invoice(s), or
bill(s) is(are)true and correct and that the
1208 71652-10282014 -509.00 $120.00 ,
materials or services itemized thereon for
which charge is made were ordered and
received except
I
Monday, December 01, 2014
Director, Adminstration
i
Title
Cost distribution ledger classification if
claim paid motor 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit,etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
10/24/14 '71652-10242014- One Center Green $360.00
10/28/14 '71652-10282014- One Center Green $120.00
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
20
Clerk-Treasurer