HomeMy WebLinkAbout257205 04/05/16 a`! CITY OF CARMEL, INDIANA VENDOR: 229400
ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURIWECK AMOUNT: $.....**120.00*
CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY-FISCAL OFFIC CHECK NUMBER: 257205
9yIFtiN�o, 302 W WASHINGTON ST,RM E221 CHECK DATE: 04/05/16
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 767503012016 120.00 BUILDING REPAIRS & MA
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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit,etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
03/01/16 7675-03012016-1 elevator operating certificate $120.00
1110 101
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
INDIANA DEPT OF HOMELAND SECURITY
DIV OF ELEVATOR SAFETY-FISCAL OFFIC IN SUM OF$
302 W WASHINGTON ST, RM E221
INDIANAPOLIS, IN 46204
$120.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police
PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members
7675-03012016-1 I 43-501.00 I $120.00 1 hereby certify that the attached invoice(s), or
1110 101
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
Monday, March 14, 2016
Cost distribution ledger classification if
claim paid motor vehicle highway fund
ELEVATOR OPERATING CERTIFICATE INVOICE
CITY OF CARMEL ONE CIVIC SQUARE CARMEL IN 46032
l.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.Over 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
45581 $120:00 $ 0.00 3 CIVIC SQ, CARMEL IN 46032
Reference Number Invoice Date Please submit ENTIRE document with payment
7675-03012016 -1 03/01/2016 Unit(s) 1 Total Due upon receipt
of 1 $ 120.00 of $ 120.00
Owner Id 7675
Ref.Num. :7675-03012016 - 1 $120 of $ 120.00 Invoice Date 03/01/2016
If Paying by check, include a check made payable to the Department of Homeland security. You can pay all your
payments online at IDHS web site https://myoracle:in:gov/dfbs/idheEeeeFinee/etart:db With-Visa/Master'_-
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Card/Discover cards. Use Owner Id on this letter or State Number on the invoice to pull up information when
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.
Full Name on Credit Card
Billing Address: Street
City State Zip Code
CC type:Visa/Am.Express/Discover/Master Card ONLY (circle one)
Acct. Number Exp.Date (mm/yy)
CVV2 Number Contact Phone Number Signature
By signing, cardmember agrees to the obligations set forth by the Cardmember's
Agreement with the issuer.
Ref.Num. :7675-03012016 - 1 $120 of $ 120.00 Invoice Date 03/01/2016