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Home My WebLink About247616 07/15/15 CITY OF CARMEL, INDIANA VENDOR: 362497 Q i ONE CIVIC SQUARE DEPARTMENT OF HOMELAND SECURITVHECK AMOUNT: $.....***50.00* 9 ,?� CARMEL, INDIANA 46032 BOILER AND PRESS.VALVE SAFETY DIV CHECK NUMBER: 247616 302 W WASHINGTON ST,RIA 246 CHECK DATE: 07/15/15 INDIANAPOLIS IN 46204-2739 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 290011 25.00 OTHER EXPENSES 651 5023990 308699 25.00 OTHER EXPENSES INVOICE FOR INSPECTION / CERTIFICATE FEES a State Form 356(R4/9-93) Approved by the State Board of Accounts-1991 Division of Fire and Building Safety 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online at[DHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbsridhsFeesFines/start.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner [don 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 462042739 up information when paying the dues online. - Telephone:(317)232-1921 INDIANA STATE NUMBER LATEST PLEASE CARMEL CITY OF 308699 INVOICE PAY THIS C/O LISA KEMPA DATE AMOUNT[ Owner Id 760 3RD AVE SW SUITE 110 U 651680 CARMEL, IN 46032 05/15/2015 Owner number User Name&Location of vessel CARMEL WASTE WTR UTILITIES Fee 9609 HAZEL DELL PKWY $ 25.00 CARMEL IN 46280 Serial number Description of vessel Manufacturer Date Last;lnspected FT Boiler HURST 03/23/2015 National Board No. Inspection agency Name of inspector (This fee is 14935 TRAVELERS REEVES JOSEPH prescribed by 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due 03/23/2015 REEVES JOSEPH RE-INSPECTION-Other-308699,05/15/201 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT -------------------------------- Tear here and retain top portion for your records ---------------------------------=--- =fATE INVOICE FOR INSPECTION / CERTIFICATE FEES �u 5 ' State Form 356(R4 9-93) cD Approved by the State Board of Accounts-1991 Division of Fire and Building Safety You can pay all your payments online at IDHS web site 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.govldfbsridhsFeesF!nesistarLdo INSTRUCTIONS: 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY with Visa/Master Card/Discover cards.Use Owner Id on Boiler and Pressure Vessel Safety Division this letter or Indiana State Number on the invoice to pull 302 W WASHINGTON ST.,RM 246 up information when paying the dues online. INDIANAPOLIS IN 462042739 Telephone:(317)232-1921 INDIANA STATE LATEST NUMBER INVOICE 308699 CARMEL CITY OF DATE PAY THIS C/O LISA KEMPA AMOUNT! i Owner Id 760--3RD AVE SW SUITE 110 05/15/2015 651680 CARMEL, IN 46032 Owner number User Name&Location of vessel CARMEL WASTE WTR UTILITIES Fee 9609 HAZEL DELL PKWY CARMEL IN 46280 $ 25.00 Serial number Description of vessel Manufacturer Date Last Inspected FT Boiler HURST 03/23/2015 National Board No. Inspection agency Name of inspector (This fee is prescribed by 14935 TRAVELERS REEVES JOSEPH 6751AC 12-3-13) INVOICE FOR INSPECTION / CERTIFICATE FEES " a State_Form 356(R4/9-93) Approved by the State Board of Accounts-1991 " Division of Fire and Building Safety 1.Mail checks payable.to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online at IDHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https:/Imyoracle.in.gov/dfbsrdhsFeesFines/starLdo INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone:(317)232-1921 INDIANA STATE NUMBER LATEST PLEASE CARMEL CITY OF 290011 INVOICE PAY THIS C/O LISA KEMPA DATE AMOUNT! Owner Id 760 3RD AVE SW SUITE 110 651680 CARMEL, IN 46032 05/15/2015 IVI Owner number User Name&Location of vessel WASTE WATER TREATMENT PLT Fee 9609 HAZEL DELL PKWY $ 25.00 INDIANAPOLIS IN 46280 _ Serial number Description of vessel Manufacturer Date Last Inspected FT Boiler BURNHAM 03/23/2015 National Board No. Inspection agency Name of inspector (This fee is 28519 TRAVELERS REEVES JOSEPH prescribed by 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due 03/23/2015 REEVES JOSEPH RE-INSPECTION-Other-290011,05/15/201 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT —_----- ------------ Tear here;and-retaintop_portion,for. srxr. INVOICE;; FOR INSPECTION / CERTIFICATE: FESS State Form 356(R4 9-93) Approved by the State Board of Accounts-1991 > „e1g Division of Fire and Building Safety You can pay all your payments online at IDHS web site 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbs/idhsFeesFines/startdo INSTRUCTIONS: 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY with Visa/Master Card/Discover cards.Use Owner Id on Boller and Pressure Vessel Safety Division this letter or Indiana State Number on the invoice to pull 302 W WASHINGTON ST.,RM 246 up information when paying the dues online. INDIANAPOLIS IN 46204-2739 Telephone:(317)232-1921 INDIANA STATE LATEST NUMBER INVOICE CARMEL CITY OF DATE PLEASE 290011 PAY THIS C/O LISA KEMPA AMOUNT! Owner Id 760 3RD.AVE SW SUITE 110 05/15/2015 I j 651680 CARMEL, IN 46032 �I VI7 Owner number User Name&Location of vessel WASTE WATER TREATMENT PLT Fee 9609 HAZEL DELL PKWY . INDIANAPOLIS IN 46280 $ 25.00 Serial number Description of vessel Manufacturer Date Last Inspected FT:Boiler BURNHAM 03/23/2015 National Board No. Inspection agency Name of inspector (This fee is 28519 TRAVELERS - - REEVES JOSEPH prescribed by 675 IAC 12-3-13) VOUCHER # 155750 WARRANT# ALLOWED 362497 IN SUM OF $ DEPARTMENT OF HOMELAND SECUF BOILER AND PRESSURE VESSEL SAF 302 W WASHINGTON ST RM 246 INDIANAPOLIS, IN 46204 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code -0 LE -7.36 W�.. '3 0gb�9 oot � i '75. C) a Voucher Total 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 362497 DEPARTMENT OF HOMELAND SECURITY Purchase Order No. BOILER AND PRESSURE VESSEL SAFETY DI% Terms 302 W WASHINGTON ST RM 246 Due Date 6/18/2015 INDIANAPOLIS, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 6/18/2015 BOILER $25.00 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