HomeMy WebLinkAbout241523 01/27/15 ,''�,\Ff CITY OF CARMEL, INDIANA VENDOR: 146900
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.�; ONE CIVIC SQUARE IN DEPT OF ENVIRONMENTAL MGMT CHECK AMOUNT: $.......100.00*
s. ?�; CARMEL, INDIANA 46032 PO BOX 3295 CHECK NUMBER: 241523
9��10N G�` INDIANAPOLIS IN 46206-3295 CHECK DATE: 01/27/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4358300 201458 100.00 OTHER FEES & LICENSES
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INVOICE
Please Remit To: . Page: 1
INDIANA DEPT.OF ENVIRONMENTAL MANAGEMENT Invoice No: 000201458
PO BOX 3295 Invoice Date: 01/15/2015
INDIANAPOLIS IN 46206-3295 Customer Number: CST100026885
Bill Type: 062
Payment Terms: NET 60
Due Date: 03/16/2015
Bill To: F6
CARMEL CLAY PARKS&RECREATION
NIS AUDREYKOSTRZEWA-FLOWING AMOUNT DUE: 100.00 USD
1411 EAST 116TH STREET E
CARMEL IN 46032JAN 2._ ��d•DU
Amount Remitted
BY
❑ Note Address Changes Above
Write t e-invoice-number-on-your_check-and_return the_upper portion of this invoice
For billing questions, please email us at WATER IDEM.IN.GOV
Line Ad' Identifier Description QuantRy UOM Unit Amt Net Amount
1 15-IN2290801T-0 PWS Fee - GW 1.00 EA 100.00 100.00
- Accounts Receivable is now accepting payment by Master Card or Visa between the hours of 9 am to 3
pm Monday through Friday. You may come to the office or call (317) 234-3099. A processing fee of
$1 plus 2% will be charged of the total transaction.
- This annual fee billing is required for active Public Water Systems (to defray the costs of
administering activities of the federal Safe Drinking Water Act) under Indiana Code: IC 13-18-20.5.
To view via the internet, visit:
- http://www.IN.gov/legislative/ic/code/titlel3/arl8/ch2O.5.html
- Fees are based on the activity status as of December 31 of the previous year.
- Fees on Transient Non-Community Water System will be based on the type of water system on record
by December 31 of the prior year.
- Fees are not pro-rated. If a system is sold or inactivated during the billing year, the, amount of
the assessed fee remains due and payable.
- If payment of the assessed fee amount imposes an undue burden on the public water system, the
facility may notify this Agency within forty-five (45) days of this invoice date to pay in four
equal installments within a year.
- Payments not received or received after the DUE date are subject to a delinquency charge equal to
10% of the assessed fee. The complete fee payment or the 1st installment is due within 60 days of
the date of this invoice.
= If several invoices are to be paid by cne_check, you MUST INCLUDE A COPY OF EACH BILLING INVOICE y
in order to ensure proper credit for each fee assessment.
-- For questions regarding your assessed fee amount, please contact Carol Guidry in the Office of
Water Quality at (317) 232-8472 or e-mail cguidry@idem.in.gov.
-IDEM may pursue enforcement action for non payment of annual fees.
TOTAL AMOUNT DUE: 100.00
Please write the invoice number on your check and return the upper portion of this invoice with remittance.
495-IDEM Printed on Recycled Paper Original
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
146900 Indiana Department of Environmental Terms
Management
P.O. Box 3295
Indianapolis, IN 46206-3295
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
1/15/15 201458 Flowing Well Safe drinking water act fee xx1633 $ 100.00
Total $ 100.00
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
Voucher No. Warrant No.
146900 Indiana Department of Environmental Allowed 20
Management
'P O Bqx 3285
Irttlranapolts, IN 46206 3295 In Sum of$
* new address
$ 100.00
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 201458 4358300 $ 100.00 1 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
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i January 22, 2015
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Signature
$ 100.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund