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Home My WebLink About246367 06/17/15 a or_t�AM Jar ` CITY OF CARMEL, INDIANA VENDOR: 146900 ® ONE CIVIC SQUARE IND DEPT OF ENVIIRONMENTAL MGT CHECK AMOUNT: $--*...**30.00* CARMEL, INDIANA 46032 own,MAIL CODE 66-34 CHECK NUMBER: 246367 100 N SENATE AVE CHECK DATE: 06/17/15 a rod�O' INDIANAPOLIS IN 46204-2251 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 7126539 30.00 OTHER EXPENSES IDEM Indiana Department of Environmental Management .� 100 N.Senate Avenue Invoice Number: 7126539 Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2015 Certificate Number: WT062539 William A.Bell Jr Expiration Date: 06/30/2015 5419 South 225 West Grade: WT3 Atlanta IN 46031 Obtained By: Examination Login ID: WT062539 Password: 582707 "{ INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. WT062539, 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 51.00 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 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 X5 (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: WT062539 Invoice Number: 7126539 PWS Name PWS ID Carmel Water Department 15229004 Address Change: Home Phone Number: 7�5 7 - Work Phone Number: 31 C� �� 3 /5 Operator Signature: Aid j Date: (2) VOUCHER # 152066 WARRANT# ALLOWED 146900 IN SUM OF $ IN DEPT. OF ENVIRONMENTAL MGT. OWQ, MAIL CODE 66-34 ; 100 N SENATE AVE ' INDIANAPOLIS, IN 46204-2251 v Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV* ACCT# AMOUNT Audit Trail Code 's 7126539 01-6040-03 $30.00 1 II a i i I t ' I 'd I 'I Voucher Total $30.00' II 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 6/6/2015 INDIANAPOLIS, IN 46204-2251 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 6/6/2015 7126539 $30.00 1 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 �•%�1,r C�.�.o_,,r,,:—�,,�,,,, ---___ Date Officer