245557 05/20/15 ;F. CITY OF CARMEL, INDIANA VENDOR: 366244
ONE CIVIC SQUARE MEDASSURE CHECK AMOUNT: $*******275.00*
CARMEL, INDIANA 46032 1013 S GIRLS SCHOOL ROAD CHECK NUMBER: 245557
INDIANAPOLIS IN 46231 CHECK DATE: 05/20/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 2062289 275.00 OTHER EXPENSES
1
MedAssure Customer Number
013 S.Girls School Road
Indianapolis, IN 46231 000240
(317)635-8000
Invoice Date
MEDAssURE 04/30/2015
Invoice Number-....
BILL TO: 002062289
Carmel Household Hazardous Waste
30 West Main
Carmel, IN 46032
TERMS DUE DATE SALES REP
SERVICE DATE Net 15 Days 05/15/2015
DESCRIPTION _J.LONT-�COUNT QTYIWGHTU NIT PRICE AMOUNT
001 -Carmel Household Hazardous-901 N Range Line Rd
Manifest#0000267069
04/30/15 31 Gallon Mixed Waste Per Container 1 11.00 25.00 275.00
CURRENT 30 DAYS 60 DAYS 90 DAYS OVER 90 DAYS Invoice Amount 275.00
275.00 0.00 0.00 0.00 0.00
do
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 5/15/2015
Invoice Invoice Description,
Date Number (or note attached invoice(s) or bill(s)) Amount
5/15/2015 2062289 $275.00
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
Date Officer
VOUCHER # 155549 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
2062289 01-736H-08 $275.00
Voucher Total $275.00
Cost distribution ledger classification if
claim paid under vehicle highway fund