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Home My WebLink About241383 01/22/15 o•.c�q.MF - > 4� - CITY OF CARMEL, INDIANA VENDOR: 00351037 ONE CIVIC SQUARE STATE OF INDIANA CHECK AMOUNT: $*****3,000.00* CARMEL, INDIANA 46032 FEDERAL SURPLUS PROP-ANGIE WHEELER CHECK NUMBER: 241383 9MIpN�� 601 W MCCARTY ST,STE 100 CHECK DATE: 01/22/15 INDIANAPOLIS IN 46225 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 652 5023990 R0214 3,000.00 OTHER EXPENSES �a STA_ State of Indiana, Return Payment/Correspondence to: Federal Surplus Property Angie Wheeler,Account Clerk 601 W. McCarty St. Ste.100 Phone:317-234-3687 Fax:317-234-3699 Indianapolis, IN. 46225 X816 Date: 01/07/15 Carmel Utilities Attn: JOHN DUFFY, UTILITY DIRECTOR 760 THIRD AVENUE SW CARMEL IN 46032 JDUFFY@CARMEL.IN.GOV Card:, 1616 Date DD#/Invoice# Amount Due 1/7/12015 R0214 $3,000.00 Total Amount Due Upon Receipt of This Notice: $ 3,000.00 l X"Please sign and date the•WHITE copy'of th`e;Yattached-Distribution Document(,s and RETURN'the WHITE" co of each with the ori iri ink si nature to our.office Com tete and retur"n any other documents,`• cop ,. � � � g. .g V p attached. Please remit•FULLt�Paymerit for the.attached Distribution Documents(s) Payment must be in the form- of 6 check drawn:from your=ORGANIZATION/AGENCY'account:_: Past Due Notice 30 Days Past-Due ;60 Days Past-Due Payment for the attached Distribution Document(s) is past-due. Please remit full payment to avoid penalties indicated below. Return of Property This account is seriously past-due (90 days). To avoid deferment, remit full payment or return the property by Temporary Deferment A letter of Deferment is enclosed because of your seriously past-due account. I State of Indiana Federal Surplus Property o�E--4TFa Phone 317/234-3685 601 West McCarty St. Fax 317/234-3699 Suite 100 eie Indianapolis, IN 46225 To:� �f1'� l� �(1� eS LJU LC Date: �' 7— Request(s) for Documentation [ Please, sign and date the Distribution Document and return it to our office to the attention of Debbie Hamilton [ � Please complete all blank areas on the attached Restricted Property Intent form and return it to our.office to the attention of Debbie Hamilton. [ ] Please have a police officer fill out the Inspection of Vehicle form on each vehicle listed on the attached paperwork and mail or fax the inspection to the attention of Vera Ferdinand. [ ] Check No. is being returned to you certified mail. Please submit payment in the form of a check drawn from the donee or anization account. Send the check to the attention of Angie Wheeler. [ ] Other: =�4 DISTRIBUTION DOCUMENT AND INVOICE DDI Number State Form 9738(R4/3-13) ®� Approved by State Board of Accounts,2013 INSTRUCTIONS: Payment must be in the form of a check drawn from the official account of the donee listed below. Mail your remittance with a copy of this invoice to: Indiana Federal Surplus Property, 601 W.McCarty Street,Suite 100,Indianapolis,IN 46225. For assistance,please call 317-234-3685. THIS INVOICE SHALL BEA TTACHED TO THE REGULAR CLAIM FORM FOR ALL POLITICAL SUBDIVISIONS(36-1-2-13). Card NumberDonee Type: Distribution Date(month,��ear � � / - Charge to(Donee) Ca r fvlo U�,i r 4-i c s Agency Clerk D14 7(p 0-�`"6 A\1e�Ve- S� Direct Pick Up 11 Warehouse Pick Up rrnk --N 4 -032- Cardholder O 2_Cardholder CountyRestriction Period: Jo 2_'q RESTRICTION Property with A/C undel Property with A/C$5,000.00 or Non-combat aircraft and Combat-Type Property is under NOTES $5,000.00 is restricted for more,and property that requires carriers are restricted for Perpetual restriction and remains the one(1)year. a title/registration are restricted five(5)years. property of the federal government. for eighteen(18)months. NOTE TO DONEE-USE OF PROPERTY REQUIREMENTS:The property listed below is federal property and will remain federal property until all requirements listed on the reverse side have been met by the donee and ownership is released by INSASP and/or GSA. NOTE TO AGENCY CLERK—Indicate the VIN for vehicles and Serial Numbers for all property with an original acquisition cost of$5,000.00 or more. 123 Number A/C Unit Cost A/C Extension Property Description Qty H/C Unit Cost H/C Extension 5-oo y 3 s:3,xq353,co I ru c k fQ n K 5 k Ki coo,cc 3 0001 bo f and �-�000 -A� 800V&KZea9 Total Original $ [ Total Handling 2 Ac uisition Cost �LI 35CC13, Charge 3.000.M I certify the materials and services shown above were furnished by INSASP;that the items of this claim are just and legal;and that there is due INSASP the amount shown above in the total handling charge column. Signature of INSASP Represent ive , 04 1 1 amu_QTcc _ I am authorized by the donee to remove the property listed above and deliver it to the donee. A letter of authorization must be attached. Signature of Transporter Printed Name Date(month,day,year) Being the duly authorized representative of the above donee,I accept the property listed above and commit the donee to comply with the terms, conditions and certifications printed on the reverse side of this document. In addition,I certify that the above donee is not presently debarred, suspended,proposed for debarment,declared ineligible,or voluntarily excluded from participation in this transaction by any Federal department or agency,as define in 41 CFR 105-68. Signature o Done epres tative Printed Name Date( onth,da,year) DIST BUTTON:Whit —Invoic angry—Donee File;Pink—Posting File;Goldenrod—Donee Copy I,-/,�-# , � _�-,�., � _ _ � -,_e,�". ( ,�.''.-,-;, J,- , I —,j1`,�f _:� i` - . — �' ' - , , �; - __ . � :,� - % 1 . - - - -, , '�,,-,' _ � - . li -I-'-. ,, _.- - _ �� :.I._ _ : � � - , � . . . � , - . i. � , _ , _ __ _ . � . ]� �, ,� c 4' . 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"� ", . , "/, . .. .i , , , ,�,-,.,-�- , I I �' �, 1, .. ,�.-Is.. _ �,��;/ _ _ _ . -:, , �- .--, _�0; ,1161 ,�,r � � — Prescribed by State Board of Accounts Form No.301-S(Rev.1997) ACCOUNTS PAYABLE VOUCHER I TO ADDRESS Invoice Date Invoice Number Item Amount i i I 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 Mo. Day Yr. Signature Title 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. Mo. Day Yr. Officer Title Voucher No. Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS MUNICIPAL WASTEWATER UTILITY ACCT. CARMEL, INDIANA No. Favor Of t e,Q Su,plQ5 N010Y11`f `Ap.o.. A �'( Whee�p�L � cat w ih,- �y Sf. st ; Ic;L• L Total Amount of Voucher $ Deductions Amount of Warrant $ SC06•) Month of Yr Acct. VOUCHER RECORD No. Collection System Pumping Treatment&Disposal Customer Accounts Administrative&Gerpral ' � f Reclaimed Water Treatment Reclaimed Water Distribution Total Allowed- Board Members Filed BOYCE FORMS•SYSTEMS 1-800-382-8702 325