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HomeMy WebLinkAbout245873 06/03/15 CITY OF CARMEL, INDIANA VENDOR: 146900 ONE CIVIC SQUARE IND DEPT OF ENVIR MGT DRINKING wpMCK AMOUNT: $.......120.00* s ?� CARMEL, INDIANA 46032 own,MAIL CODE 66-34 CHECK NUMBER: 245873 100 N SENATE AVE CHECK DATE: 06/03/15 INDIANAPOLIS IN 46204-2251 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 7125977 30.00 OTHER EXPENSES 601 5023990 7126046 30.00 OTHER EXPENSES 601 5023990 7126049 30.00 OTHER EXPENSES 601 5023990 7126612 30.00 OTHER EXPENSES 1EW-n Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number: 7126046 Mail Code 66-34 . Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2015 - Certificate Number: DS063078 Expiration Date: 06/30/2015 JERRY G. SMITH IV Grade: DSL 3450 WEST 131ST STREET Obtained By: Examination Westfield IN 46074 Login ID: DS063078 Password: 582706 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works"Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. DS063078, Grade DSL for a class DSL Water Distribution System expires on June 30, 2015. You are required to obtain 15.00 contact hours of continuing education for renewal. Our records indicate that you currently have accumulated 38.00 contact 0 hours towards renewal. (This may not reflect hours for courses recently attended.) Note: If you have not recently attended an approved course, and you do not have the required number of hours, you need to attend courses prior to July 1, 2015. After this date you are on expired status and are not a valid certified operator. You do have until July 1,2016 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2016 will result in termination of your certification, and you will have to retest. Online Renewal—Online renewal is available 24 hours a day, 7 days a week at https://my license.in.gov. The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal. The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID and Password are listed above. Mail Renewal,=To renew through the mail,please fill out the section on the back of this page and return this entire letter with $30 fee payment to the remittance address-listed. Be sure to sign and date in spaces provided.--Make a photocopy for your records. Please note that renewal through the mail will take longer than an online renewal. If you have other drinking water certifications due renewal, you can combine.them in one mailing with a fee payment that covers all of them. For example: (3 renewals x$30/per renewal) _$90 combined fee. Remit Payment to: Indiana Department of Environmental Management Drinking Water Branch, OWQ,Mail Code 66-34 100 N. Senate Avenue Indianapolis, IN 46204-2251 SEE FORM ON OTHER SIDE �^ (1) 09 "CANCEL" Cancel Certification—If you do not want to renew this certification, lease write CANCEL on this . Y p form, sign and date in spaces provided, and mail to the remittance address listed. FILL OUT &RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING If this certification was obtained by Examination and the facility you are employed at has changed,please add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site Specific,it is valid only for the location below. Operator Number: DS063078 Invoice Number: 7126046 PWS Name PWS ID Carmel Water Department 15229004 Address Change: Home Phone Number: Work Phone Number: � Operator Signature: Date: S -a -/c (2) . Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number: 7125977 Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt t# (Office Only) May 18,2015 Certificate Number: DS063092 SEAN W.WHITLOW Expiration Date: 06/30/20.15 3450W. 131st St. Grade: DSL Westfield IN 46074 Obtained By: Examination Login ID: DS063092 Password: 579828 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT - Water Works Operator Certification Renewal Fee Statement. Our records indicate your Water Works Certificate No. DS063092, Grade DSL for a class DSL Water Distribution System expires on June 30, 2015. You are required to obtain 15.00 contact hours of continuing education for renewal. Our records indicate that you currently have accumulated 36.50 contact 0 hours towards renewal. (This may not reflect hours for courses recently attended.) Note: If you have not recently attended an approved course, and you do not have the required number of hours, you need to attend courses prior to July 1, 2015. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2016 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2016 will result in termination of your certification, and you will have to retest. Online Renewal—Online renewal is available 24 hours a day, 7 days a week at https://mylicense.in.gov. The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal. The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID and Password are listed above. Mail Renewal--To renew through the mail,please fill out the section on the back of this page and return this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in spaces provided: Make a photocopy for your records. Please note that renewal through the.mail will take longer than an online renewal. If you have other drinking water certifications due renewal, you can combine them in one mailing with a fee payment that covers all of them. For example: (3 renewals x $30/per renewal)_$90 combined fee. Remit Payment to: Indiana Department of Environmental Management: Drinking Water Branch, OWQ, Mail Code 66-34 100 N. Senate Avenue Indianapolis, IN 46204-2251 SEE FORM ON OTHER SIDE �Q (1) Cancel Certification—If you do not want to renew this certification,please write "CANCEL" on this form, sign and date in spaces provided, and mail to the remittance address listed. FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING If this certification was obtained by Examination and the facility you are employed at has changed,please add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site Specific,it is valid only for the location below. Operator Number: DS063092 Invoice Number: 7125977 PWS Name PWS ID Carmel Water Department 15229004 Address Change: 4 Home Phone Number: 17- 1 -5© /' G' T 5 Work Phone Number: c2� -7— �O —( 1 Jc—// ®VD--e . 31-7- -7 33-,2?9 Date: Operator Signature: (2� Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number: 7126612 Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2015 Certificate Number: WT 120205 Jacen H.Rayle Expiration Date: 06/30/2015 Grade: WT3 23690 Dunbar Rd. Obtained By: Examination Arcadia IN 46030 Login ID: WT120205 Password: 1484442 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. WT 120205, Grade WT3 for a class WT3 Water Treatment Plant expires on June 30,2015. You are required to obtain 25.00 contact hours of continuing education for renewal. Our records indicate that you currently have accumulated 87.00 contact hours 0 towards renewal. (This may not reflect hours for courses recently attended.) Note: If you have not recently attended an approved course, and you do not have the required number of hours, you need to attend courses prior to July 1, 2015. After this date you are on expired status and are not N a valid certified operator. You do have until July 1, 2016 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2016 will result in termination of your certification, and you will have to retest. Online Renewal—Online renewal is available 24 hours a day, 7 days a week at Wps://mylicense.in.gov. The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal. The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID and Password are listed above. Mail Renewal—To renew through the mail,please fill out the section on the back of this page and return this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in . spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take longer than an online renewal. If you have other drinking water certifications due renewal,you can combine them in one mailing with a fee payment that covers all of them. For example: (3 renewals x $30/per renewal) _$90 combined fee. Remit Payment to: Indiana Department of Environmental Management Drinking Water Branch, OWQ, Mail Code 66-34 100 N. Senate Avenue Indianapolis, IN 46204-2251 SEE FORM ON OTHER SIDE . (1) Cancel Certification—If you do not want to renew this certification,please write"CANCEL" on this form, sign and date in spaces provided, and mail to the remittance address listed. FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING If this certification was obtained by Examination and the facility you are employed at has changed,please add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site Specific,it is valid only for the location below. Operator Number: WT120205 Invoice Number: 7126612 PWS Name PWS ID Carmel Water Department 15229004 Address Change: Home Phone Number: Work Phone Number: 317)t 0-7 --S(oc Operator Signature: Date: 5/27 rS (2) VOUCHER # 152015 WARRANT# ALLOWED 146900 IN SUM OF $ �,, IN DEPT. OF ENVIRONMENTAL MGT. OWQ, MAIL CODE 66-34 100 N SENATE AVE INDIANAPOLIS, IN 46204-2251 !, Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR ' 11� ' ! Board members PO# INV# ACCT# AMOUNT I Audit Trail Code 7126046 01-6040-05 $30.00 i I i. Voucher Total 90 o Ij 1 Cost distribution ledger classification if claim paid under vehicle highway fund j 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 146900 IN DEPT. OF ENVIRONMENTAL MGT. Purchase Order No. OWQ, MAIL CODE 66-34 Terms 100 N SENATE AVE Due Date 5/27/2015 INDIANAPOLIS, IN 46204-2251 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/27/2015 7126046 $30.00 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 2-115 Date Officer Indiana Department of l t var0nmental Management Nc1 .1Db N Senate Avenue Invoice Number: 7126049 " t �Mail Code 66-34 P` Renewal Fee: 30.00 tet{ti`y Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2015 Certificate Number: DS063072 Expiration Date: 06/30/2015 MICHAEL E.LUPER II Grade: DSL 3450 W. 131st St. Obtained By: Examination Westfield IN 46074 Login ID: DS063072 Password: 582715 O INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT -- -- 1lzter 'l�'oks;Operator Cetttfzca'tzon Renewal Fee Statement Our records indicate your Water Works Certificate No. DS063072, Grade DSL for a class DSL Water Distribution System expires on June 30, 2015. You arex6quired to obtain 15.00 contact hours of continuing education for renewal. Our records:indicate that you currently have accumulated 34.00 contact s hours towards renewal. (This may not reflect hours.for courses recently attended.) E Note: If you have not recently attended an approved,course, and you do not have the required number of hours,you need'to attend courses prior to July,1, 2015, After this date you are;on expired status and are not a valid certifled,o erator. You do have until July 1,2Q16'to get your continuing.education,hours and renew your certification Failure to renew by July 1;_,2016 w ll.result in termination ofyour certification, and you will have to retet Online Renewal Online.xenewal is available 24...' rs a day, 7 days a week at httpsJ/mylxcense in ov.` The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal. The forms of payment accepted online are Vi'sa,.>Ma�ter Card, t4c Discover credit and debit cards; Login ID }t}t and Password are listed`above. ^`��1 dI o hough;the mail,please fill otit the section on the Back of this page and return 1lre�new1etiew t ,,,, xt f ftTcg .e =e>r V►1t. Q. gay3nent xo-tl ' +dress-iisted -Ee sore to sign and"date in spaces provided. Make a photocopy for your records..Please note that renewal through the mail will take longer than an online renewal If you have other drinking wAA16 certifications due renewal, you can combine them in one mailing with a fee payment that covers ail of them. For example: (3 renewals x $30/per renewal)_$90 combined fee. Remit Payment to: Indiana Department of Environmental Management Drinking Vater Branch, OWQ, Mail Code 66-34 100 N. Senate avenue Indianapolis;.,IN 4G 04-2251 SEEF"RM ON OTHER SIDE y t 5 7faf 4.i fS T It - - v) + Y t nth; s $iw�til,� Cancel Certification—If you do not want to renewIthis certification,please write "CANCEL"on this A4 15 form, sign and date in spaces provided, and.rna�l to the remittance address listed. FILL OUT& RETURN ENTIRE UTTER)VHE R 1�1E 'l�i'�1G`BY MAIL OR CANCELLING If this certification was obtained by Exanunat on arid;he acil�>t ou employed at has changed,please add your new employer in the space provided. NO' t'It � c `ificaton is Grandfathered or Site Specific,itis valid only for the location f x , Operator Number: DS063072 r finyo ce- umber: 7126049 r . ' s. �Ir,+v iF71 t PWS Name n'... Carmel Water Department �' 5�22 'n ���"�� s , ( r ,!'M1 K rte 5 �C Address Change. s �s• { tC st� Ir r�n aM1t �a x �cSGG xl�i r s � l o !t� i�kdt i'14�a 1i'Ir sit n I I rl n npsr +fZ fh.+f �a � s j t 4 , I I. 14 ;( rst isI 4 l yi,nlwts 1yM1 Home Phone Number: �30) ?2-� 20� 1 -2l0 Work Phone Number: (3�� �33 n Sc Operator Signature: � �1.- ��sa-b- _:, {' t+ t Rate2 I t' t 4 r - 3 - { �' nN , S S " y 7`•':4Y r z t� r { " r� ENI aft yY� (2) i VOUCHER # 152020 WARRANT# ALLOWED IN SUM OF $ 146900 IN DEPT. OF ENVIRONMENTAL MGT. I OWQ, MAIL CODE 66-34 100 N SENATE AVE INDIANAPOLIS, IN 46204-2251 1 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT , Audit Trail Code 7126049 01-6040-05 $30.00 + Voucher Total $30.00 Cost distribution ledger classification if claim paid under 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 of service rendered,,by whom, rates per day, number of units, price per unit, etc. Payee 146900 IN DEPT. OF ENVIRONMENTAL MGT. Purchase Order No. OWQ, MAIL CODE 66-34 Terms 100 N SENATE AVE Due Date 5/29/2015 INDIANAPOLIS, IN 46204-2251 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/29/2015 7126049 $30.00 i 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