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Home My WebLink About259311 06/03/16 `%'��p''F• CITY OF CARMEL, INDIANA VENDOR: 362110 `= '� CHECK AMOUNT: $********30.00* .,; � 3.• ONE CIVIC SQUARE BRIAN TOLAN 49 �; CARMEL, INDIANA 46032 608 S UNION ST CHECK NUMBER: 259311 y4 roN� WESTFIELD IN 46074 CHECK DATE: 06/03/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 7683673 30.00 OTHER EXPENSES VOUCHER # 161610 WARRANT # ALLOWED 362110 IN SUM OF $ TOLAN, BRIAN CARMEL WATER Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 7683673 01-6040-03 $30.00 Voucher Total $30.00 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 362110 TOLAN, BRIAN Purchase Order No. CARMEL WATER Terms Due Date 5/31/2016 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/31/2016 7683673 $30.00 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 2-2566/710 3670 BRIAN S TOLAN 608 S UNION ST. WESTFIELD,IN 46074-9302DA1, MAY 25 2oib TH ORDEROFE LIUDIdVA AI�T�Le oc ENVI140&jMGkff4 : $ 313, Tia►rZz'y a�� D�!/�,S DOLLARS LrJ i 3 BMO ® Harris Bank BMO Harris Bank N.A. o ,r'y„�LILLg./ ,t Chicago,Illinois MEMO •77-''r4��E1C�bNE�'L fYl' 1:0710256E0: 1SO0433BP3110 03670 j A ,. Fil FOREVER ®. M ol>IA1VQ CWT OF Adil��u1 6�T, �tBAc7 Dy.ijvkault9)4-t6X UI,A00"t OWQJ htA+c e&aG oto Aver, pry Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number: 7683673 s Mail Code 66-34 Renewal Fee: 30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 18,2016 Certificate Number: WT130184 Expiration Date: 06/30/2016 Brian S.Tolan Grade: WT5 Carmel Water Utilities Obtained By: Examination 608 South Union Street Westfield IN 46074 Login ID: WT130184 Password: 582719 " INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. WT130184, Grade WT5 for a class WT5 Water Treatment Plant expires on June 30, 2016. You are required to obtain 30.00 contact hours of continuing education for renewal; a minimum of 70%must be technical. Our records indicate that you currently have accumulated 48.00 contact hours towards renewal. (This may not reflect hours for courses recently attended.) If you need to verify the number of technical course hours obtained, you may login online using o, the instructions below. Note: If you have not recently attended an approved course, and you do not have the required number of hours,you need to attend courses prior to July 1, 2016. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2017 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2017 will result in termination of your certification, and you will have to retest. Online Renewal—Online renewal is available 24 hours a day, 7 days a week at httys://mylicense.in.gov. The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal. The forms of payment accepted online are Visa, Master Card, &Discover credit and debit cards. Login ID and Password are listed above. Mail Renewal—To renew through the mail,please fill out the section on the back of this page and return this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in. spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take longer than an online renewal. If you have other drinking water certifications'due renewal, you can combine them in one mailing with a fee payment that covers all of them. For example: (3 renewals x$30/per renewal) _ $90 combined fee. Remit Payment to: Indiana Department of Environmental Management ` Drinking Water Branch, OWQ,Mail Code 66-34 100 N. Senate Avenue Indianapolis, IN 46204-2251 SEE FORM ON OTHER SIDE (1) Cancel Certification—If you do not want to renew this certification,please write"CANCEL" on this form, sign and date in spaces provided, and mail to the remittance address listed. FILL OUT & RETURN ENTIRE LETTER-WHEN RENEWING BY MAIL OR CANCELLING If this certification was obtained by Examination and the facility you are employed at has changed,please . add your new employer in the space provided. NOTE—If this certification is Grandfathered or Site { Specific, it is valid only for the location below. Operator Number: WT130184 Invoice Number: 7683673 PWS Name- PWS ID Carmel Water Department 15229004 Address Change: Home Phone Number: 31-7 w W 7 5003 Work Phone Number: 317 733 2956Operator Signature: Date: Gu�'� 2�, 210 6 .