HomeMy WebLinkAbout252321 1 2/08/1 5 *f - CITY OF CARMEL, INDIANA VENDOR: 229400
i; ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURIl41-IECK AMOUNT: $"`';""240.00"
a CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY-FISCAL OFFIC CHECK NUMBER: 252321
302 W WASHINGTON ST,RM E221 CHECK DATE: 12/08/15
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4350900 734241 240.00 OTHER CONT SERVICES
t
I
t ELEVATOR OPERATING CERTIFICATE INVOICE
t ARMEL/CLAY BOARD OF PARKS & RECREATION 1411 E 116TH ST Pat Schlemmer CARMEL IN 46032
1.If Code = * An annual test report is due before a permit is issued.
2.If Code = # A 5 year Test report is due before a permit is issued.
3.0ver due fees must be paid before a permit is issued.
If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE
AFFIRMATION" form.
State No.Code Due Over Due Location Address
111704 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 46032
111978 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 46032
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DEC - 3 2015
BY:
Please submit ENTIRE document wit
Reference Number Invoice Date
h payment
734241-11302015 -1 11/30/2015 Unit(s) 2 Total Due upon receipt
of 2 $ 240.00 of $ 240.00
Owner Id 734241
Invoice Date 11/30/2015
Ref.Num. :734241-11302015 - 1 $240 of $ 240.00
� if Paying by check, include a check made payable to the Department of Homeland security. You can pay all your
I payments online at IDHS web site https://myoracle.in.gov/dfbs/idheFeesFines/start.do with Visa/Master
i
Card/Discover cards. Use Owner Id on this letter or State Number on the invoice to pull up information when
1 paying the dues online.OR complete the following information and return by mail :Indiana Department of
Homeland Security, Fiscal Department, 302 W.Washington St., Rm : E221,Indianapolis, IN 46204 or fax to
(317)233-0401. Questions? call(317)232-6427 or E-mail:elevator-invoice®dhs.in.gov 2.25% convenience fee
} charged on all credit card payments.
i
I
I Full Name on Credit Card
Billing Address: Street
j State Zip Code
City
CC type:Visa/Am.Express/Discover/Master Card ONLY (circle one)
Acct. Number Exp.Date (mm/yy)
1
J CWSignature Number Contact Phone Number g
4 By signing, cardmember agrees to the obligations set forth by the Cardmember's
Agreement with the issuer.
� Invoice Date 11/30/2015
Ref.Num. :734241-11302015 - 1 $240 of $ 240.00
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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.
of Homeland 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
11/30/15 113020151 Elevator permits 2016 xx3072 $ 240.00
Total $ 240.00
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
120
Clerk-Treasurer
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$
$ 240.00
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
PO#or INVOICE NO. CCT#/TITL AMOUNT Board Members
Dept#
1093 113020151 4350900 $ 240.00 ( 1 hereby certify that the attached invoice(s), or
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
December 4, 2015
Signature
$ 240.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
F:
claim paid motor vehicle highway fund
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Fr'.