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247326 07/15/15 CITY OF CARMEL, INDIANA VENDOR: 229400 4� �f ONE CIVIC SQUAF E INDIANA DEPT OF HOMELAND SECURIMECK AMOUNT: $*i******250.00* r. � CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY•FISCAL OFFIC CHECK NUMBER: 247326 302 W WASHINGTON ST,RM E221 CHECK DATE: 07/15/15 t-�rori�O' INDIANAPOLIS IN 46204 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1093 4239099 25.00 304619 1093 4239099 25.00 304620 1093 4239099 25.00 304623 1093 4239099 25.00 304624 1093 4239099 25.00 304625 1093 4239099 25.00 304626 1093 4239099 25.00 304627 1093 4239099 25.00 304628 1093 4239099 25.00 304629 1093 4239099 25.00 323313 I I INVOICE FOR INSPECTION / CERTIFICATE FEES �V State Form 356(R4/9-93) Approved by the State Board of Accounts-1991 Division of Fire and Building Safety 1.Mail checks payable &c DEPARTMENT OF HOMELAND SECURITY 2. Mail 2nd copy&check You can pay all your payments online at IDHS web site k to DEPARTMENT HOMELAND SECURITY INSTRUCTIONS: Boiler and Pressure with Visa/Master Card/Discover cards.Use Ownehttps://myoracle.in.gov/dfbsildhsFeesFines/str arLdo e Vessel Safety Division Id on this letter or Indiana State Number on the invoice to pull 302 W WASHINGTON ST.,RM 246 � INDIANAPOLIS IN 46204-2739 up information when paying the dues on Telephone:(317)232-1921 INDIANA STATE NUMBER CARMEL CLAY PARKS & RECREATION LATESTLAMOUNTI EASE 304620 INVOICE His 1411 E 116TH ST DATE Owner Id ATTN DAWN KOEPPER 759531 CARMEL, IN 46032-3455 06/22/2015 ;User Name&Location of vessel \/ Owner number MONON COMMUNITY CTR Fee X1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected WiT Bir Hot Water Heating BRYAN 04/20/2015 National Board No. Inspection agency Name of inspector (This fee is 53259 TRAVELERS REEVES JOSEPH prescribed by 675 IAC 12-3-13) I Inspection Date Inspector Name Inspection Type Due I ' 04/20/2015 REEVES JOSEPH RE-INSPECTION--304620,06/22/2015 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT INVOICE FOR INSPECTION / CERTIFICATE FEES u State IForm 356(R4/9-93) j' Approved by the State Board of Accounts-1991 Division of Fire and Building Safety aw Wx n,e 1.Mai 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.govldfbs/idhsFeesF!nes/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 LAMOUNTI EASE CARMEL CLAY PARKS & RECREATION 304623 INVOICE THIS 1411 E •116TH ST DATE Owner Id CARMEL, IN 46032-3455 759531 06/22/2015 Owner number User Name&Location of vessel MONON COMMUNITY CTR Fee J ,1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected WRT Boiler LOCHSNVAR - .04/20/2015 National Board No. Inspection agency Name of inspector (This fee is 184067 TRAVELERS REEVES JOSEPH prescribed by 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due I I 04/20/2015 REEVES JOSEPH RE-INSPECTION--304623,06/22/2015 $ 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 vour records —--------------------------- I INVOICE FOR INSPECTION / CERTIFICATE FEES 2 StatelForm 356(R4/9-93 Na 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 of IDHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https,//myoracle.in.govldfbs/idhsFeesF!nes/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 PAY TH CARMEL CLAY PARKS & RECREATION 304624 INVOICE IS 1411 E 116TH ST DATE AMOUNTI Owner Id CARMEL, IN 46032-3455 06/22/2015 � 7 759531 Owner number (User Name&Location of vessel MONON COMMUNITY CTR Fee ,1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected W T Boiler LOCHINVAR 04/20/2015 National Board No. Inspection agency Name of inspector (This fee is 195396 TRAVELERS REEVES JOSEPH prescribed by 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due I 04/20/2015 REEVES JOSEPH RE-INSPECTION--304624,06/22/2015 S 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 ----------------------- k 'b INVOICE FOR INSPECTION / CERTIFICATE FEES v t State(Form 356(R4/9-93) p 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 of IDHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https:l/myoracle.in.gov/dfbs/ldhsFeesFines/siartdo 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 CLAY PARKS & RECREATION 304625 INVOICE PAY THIS 1411 E 116TH ST DATE AMOUNTI Owner Id CARMEL IN 46032-3455 — 06/22/2015 ,7 759531 Owner number User Name&Location of vessel THE MONON CTR Fee ;1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected WIT Boiler - LOCHI*NAR 04/20/2015 National Board No. Inspection agency Name of inspector (This fee is 181548 TRAVELERS REEVES JOSEPH prescribed by 675 IAC 12-3-13) Inspection Date in Name Inspection Type Due 1 04/20/2015 REEVESJOSEPH RE-INSPECTION--304625,06/22/2015 S 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 too portion for your records ------------------------ i ,.s"u s ary �� 2 INVOICE FOR INSPECTION / CERTIFICATE FEES -� State IForm 356(R4/9-93) ( A Approved by the State Board of Accounts-1991 ' w Y Division of Fire and Building Safety n a 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 hftps:l/myoracle.in.gov/dfbs/ldhsFeesFines/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 CLAY PARKS Sc RECREATION 304626 INVOICE PAY THIS 1411 E 116TH ST DATE AMOUNTI Owner Id CARMEL, IN 46032-3455 06/22/2015 759531 - J Owner number (User Name&Location of vessel THE MONON CTR Fee 11235 CENTRAL PARK DR E $ 25.00 i CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected WIT Boiler- LOCHINVAR 04/20/2015 - I National Board No. Inspection agency Name of inspector (This fee is 181626 T VELERS REEVES JOSEPH prescribed by 675 IAC 12-3-13) Inspection Date In Name Inspection Type Due, 1 04/20/2015 REEVES JOSEPH RE-INSPECTION--304626,06/22/2015 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT -----------r------------ Tear here and retain top portion for your records ---------------------------------------- I INVOICE FOR INSPECTION / CERTIFICATE FEES w StatelForm 356(R419-93) (Y x Approved by the State Board of Accounts-1991 ' Division of Fire and Building Safety �„ Ma 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:llmyoracle.in.gov/dfbs/idhsFeesFines/start.do 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 CLAY PARKS & RECREATION 304627 INVOICE PAY THIS 1411 E 116TH ST DATE AMOUNTI Owner Id CARMEL, IN 46032-3455 06/22/2015 �I 759531 Owner number User Name&Location of vessel THE MONON CTR Fee 1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 i Serial number Description of vessel Manufacturer Date Last Inspected WIT Boiler LOCHINVAR 04/20/2015 National Board No. Inspection agency Name of inspector (This fee is 181533 TRAVELERS REEVES JOSEPH prescribed by 675 IAC 12-3-13) . Inspection Date in spector Name Inspection Type Due I 04/20/2015 REEVES JOSEPH RE-INSPECTION--304627,06/22/2015 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT I ----- — Tear here and retain top portion for your records --------- I INVOICE FOR INSPECTION / CERTIFICATE FEES AState'Form 356(R4/9-93) a £° m Approved by the State Board of Accounts-1991 Division of Fire and Building Safety 1.Me 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 haps://myoracle.in.gov/dfbs/IdhsFeesFines/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 CLAY PARKS & RECREATION 304628INVOICE PAY THIS 1411 E 116TH ST DATE AMOUNTI Owner Id CARMEL, IN 46032-3455 1 j 06/22/2015 � 7 759531 Owner number !User Name&Location of vessel THE MONON CTR Fee '1235 CENTRAL PARK DR E $ 25.00 (CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected WIT Boiler LOCHINVAR 04/20/2015 National Board No. Inspection agency Name of inspector (This fee is 181629 TRAVELERS REEVES JOSEPH prescribed by 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due I 04/20/2015 REEVES JOSEPH RE-INSPECTION--304628,06/22/2015 $ 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 --------------------------------------- INVOICE FOR INSPECTION / CERTIFICATE FEES State IForm 356(R4/9-93) + >E 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 tAW 1.Ma I checks payable to DEPARTMENT OF HOMELAND SECURITY 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https:l/myoracle.In.govldfbslldhsFeesFines/siarLdo 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 LAMOUNTI EASE CARMEL CLAY PARKS & RECREATION 304629 1411 E 116TH ST INVOICE Is PAY T I Owner id CARMEL, IN 46032-3455 06/22/2015 � 7 759531 Owner number User Name&Location of vessel THE MONON CTR Fee 1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected W!T Blr - Hot Water Heating LOCHINVAR 04/20/2015 National Board No. Inspection agency Name of inspector (This fee is TRAVELERS REEVES JOSEPH prescribed by 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due I 04/20/2015 REEVES JOSEPH RE-INSPECTION--304629,06/22/2015 S 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 ------------------------------------------ 4=°" INVOICE FOR INSPECTION / CERTIFICATE FEES State Form 356(R4/9-93) -+/ Approved by the State Board of Accounts-1991 " Division of Fire and Building Safety a�w 1.Ma 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:Hmyoracle.in.gov/dfbs/idhsFeesFines/siart.do 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 CARMEL CLAY PARKS & RECREATION LATEST PLEASE 323313' INVOICE PAYTHIS 1411 E 116TH ST DATE AMOUNTI I I Owner Id CARMEL, IN 46032-3455 06/22/2015 ` 7 759531 Owner number User Name&Location of vessel MONON COMMUNITY CENTER Fee 1195 CENTRAL PARK DR W $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected WIT Boiler LOCHINVAR 04/20/2015 1 National Board No. Inspection agency Name of inspector (This fee is 238763 TRAVELERS REEVES JOSEPH prescribed by 675 IAC 12-3-13) i Inspection Date Inspector Name Inspection Type Due I 04/20/2015 REEVES JOSEPH RE-INSPECTION--323313,06/22/2015 $ 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 --------------------------------------- I � h" INVOICE FOR INSPECTION / CERTIFICATE FEES StatelForm 356(R4/9-93) Approved by the State Board of Accounts-1991 m n I 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://myoracle.in.govldfbs/idhsFeesFines/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 CLAY PARKS & RECREATION 304619 1PAY THIS CE 411 E 116TH ST INVOICE AMOUNT[ I Owner Id CARMEL, IN 46032-3455 06/22/2015 759531 IVI Owner number User Name&Location of vessel MONON COIMMUNITY CTR Fee [1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer Date Last Inspected W!T Blr - Hot Water Heating BRYAN 04/20/2015 National Board No. Inspection agency Name of inspector (This fee is 53252 TRAVELERS REEVES JOSEPH prescribed by 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due 04/20/2015 REEVES JOSEPH RE-INSPECTION--304619,06/22/2015 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT i ------- ---- - Tear here and retain top portion for your records ----------------------------- 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 229400 Indiana Department Purchase Order No. j of Home(land Security Terms Fiscal Department 302 W Washington St., Rm E221 Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s)or bill(s)) PO# Amount 6/22/15 304620 Boiler inspections xx2371 $ 25.00 6/22/15 304623 Boiler inspections xx2371 $ 25.00 6/22/15 —3046N Boiler inspections xx2371 $ 25.00 6/22/15 304626 Boiler inspections xx2371 $ 25.00 6/22/15 304625 Boiler inspections xx2371 $ 25.00 6/22/15 304629 Boiler inspections xx2371 $ 25.00 6/22/15 304628 Boiler inspections xx2371 $ 1 25.00 6/22/15 304627 Boiler inspections )oQ371 $ 25.00 6/22/15 323;313 Boiler inspections xx2371 $ 25.00 6/22/15 304,619 Boiler inspections xx2371 $ 25.00 Total $ 250.00 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 , 20 Clerk-Treasurer i Voucher No. Warrant No. Indiana Department 229400 of Homeland Security Allowed 20 Fiscal Department 302 W Washington St., Rm E221 Indianapolis, IN 46204 In Sum of$ $ 250.00 ON ACCOUNT OF APPROPRIATION FOR i I 109 -Monon Center PO#or Board Members Dept# INVOICE NO. ACCT#/TITL AMOUNT 1093 304620 4239099 $ 25.00 1 hereby certify that the attached invoice(s), or 1093 304623 4239099 $ 25.00 bill(s)is(are)true and correct and that the 1093 304624 4239099 $ 25.00 �, materials or services itemized thereon for 1093 304626 4239099 $ 25.00 which charge is made were ordered and 1093 304625 4239099 $ 25.00 ;; received except 1093 304629 . 4239099 $ 25.00 1093 304628 4239099 $ 1093 304627 4239099 $ 25.00 1093 323313 4239099 $ 25.00 1093 304619 4239099 $ 25.00 July 9,2015 'P Signature $ 250.00 i Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund