HomeMy WebLinkAbout239708 12/03/14 CITY OF CARMEL, INDIANA VENDOR: 362497
t( ONE CIVIC SQUARE DEPARTMENT OF HOMELAND SECURITQHECK AMOUNT: $*******120.00*
CARMEL, INDIANA 46032 BOILER AND PRESS.VALVE SAFETY DIV CHECK NUMBER: 239708
q�i roNi%°' 302 W WASHINGTON ST,RM 246 CHECK DATE: 12/03/14
INDIANAPOLIS IN 46204-2739
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1208 4350900 10282014-1 120.00 OTHER CONT SERVICES
ELEVATOR OPERATING CERTIFICATE INVOICE
j' RMEL 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.
j 3.Over due fees must be paid before a permit is issued.
t
If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE
AFFIRMATION" form.
State No.Code Due Over Due Location Address
t —
t 113741 * $120.00 $ 0.00 ONE CENTER GREEN, CARMEL IN 46032
Submitted To
DEC 0 12014
Clerk Treasurer
Reference Number- Invoice Date Please submit ENTIRE document with payment
I 771652-10282014 -1 10/28/2014 Unit(s) 1 Total Due upon receipt
of 1 $
120.00 of $ 120.00
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Owner Id 771652
1
? Ref.Num. :771652-10282014 -1 $120 of $ 120.00 Invoice Date 10/28/2014
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://myoracle.in.gov/dfbs/idhsFeesFines/start.do with Visa/Master
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 4620.4 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.
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Full Name on Credit Card
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Billing Address: Street
t
j City State Zip Code
i CC type:Visa/Am.Express/Discover/Master Card ONLY (circle one)
1i{ Acct. Number Exp.Date (mm/yy)
1
r CVV2 Number Contact Phone Number Signature
1
By signing, cardmember agrees to the obligations set forth by the Cardmember's-
Agreement with the issuer.
Ref.Num. :771652-10282014 -1 $120 of $ 120.00 Invoice Date 10/28/2014
VOUCHER NO. WARRANT NO.
ALLOWED 20
Department of Homeland Security
i IN SUM OF $
Indiana Dept of Homeland Security, Fiscal Dept I
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 i
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
Monday, December 01, 2014
Director, Adminstration
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