252051 1 2/02/1 5 coq .
CITY OF CARMEL, INDIANA VENDOR: 366244
ONE CIVIC SQUARE MEDASSURE CHECK AMOUNT: $**.....330.00*
?� CARMEL, INDIANA 46032 1013 S GIRLS SCHOOL ROAD CHECK NUMBER: 252051
MoH,Lo, INDIANAPOLIS IN 46231 CHECK DATE: 12/02/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 2176329 330.00 OTHER EXPENSES
--�' MedAssure
Customer Number
1013 S.Girls School Road
Indianapolis, IN 46231 000240
URE (317)635-8000
MEDAss Invoice Date
10/31/2015
Invoice Number
';✓.' Dorf ST..I n
BILL TO: 002176329
Carmel Household Hazardous Waste
30 West Main
Carmel, IN 46032
TERMS DUE DATE SALES REP
SERVICE DATE Net 15 Days 11/15/2015
DESCRIPTION CONT.COUNT QTYMGHT UNIT PRICE AMOUNT
001 -Carmel Household Hazardous-901 N Range Line Rd
Manifest#0000301238
10/07/15 31 Gallon Mixed Waste Per Container 1 11.00 30.00 330.00
CURRENT 30 DAYS 60 DAYS 90 DAYS OVER 90 DAYS
Invoice Amount 330.00
330.00 0.00 0.00 0.00 0.00
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 11/23/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/23/201! 2176329 $330.00
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
11."'Oolt
Date Pfficer
i
VOUCHER # 156678 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
2176329 01-720H-08 $330.00
Voucher Total $330.00
Cost distribution ledger classification if
claim paid under vehicle highway fund