HomeMy WebLinkAbout259099 05/31/16 CITY OF CARMEL, INDIANA VENDOR: 366244
h ONE CIVIC SQUARE MEDASSURE CHECK AMOUNT: $'+"'"'390.00`
CARMEL, INDIANA 46032 149 YELLOWBROOK ROAD CHECK NUMBER: 259099
SUITE 100 CHECK DATE: 05/31/16
FARMINGDALE NJ 07727
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 W14410 390.00 OTHER EXPENSES
VOUCHER # 165348 WARRANT# ALLOWED
366244 IN SUM OF $
MEDASSURE ! r
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Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
W14410 01-720H-08 $390.00
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Voucher Total $390.00
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
366244
MEDASSURE Purchase Order No.
1013 S GIRLS SCHOOL ROAD Terms
INDIANAPOLIS, IN 46231 Due Date 5/16/2016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/16/2016 W14410 $390.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
;orrect and I have audited same in accordance with IC 5-11-10-1.6
Date Officer
Invoice
_ MedAssure Date Invoice No.
_ 149 Yellowbrook Road 04/07/2016 W 14410
Suite 100
E DA.*:i S U Rt Farmingdale, NJ 07727 Terms Due Date
(732) 363-7444
billing@medassureservices.com Net 30 05/07/2016
Bill To: Customer ID: (4393-8324) Ship To:
Carmel Household Hazardous Waste Carmel Household Hazardous Waste
30 West Main 901 N Range Line Rd
Carmel, IN 46032 Carmel, IN 46032
Tracking #: 8324-04-06-2016-205815-B
SIC# Tax Exempt ID# Balance Due Enclosed
$390.00 -490,00
PO Number# Ship Date Ship Via
04/07/2016 MedAssure
Date Description Quantity Rate Amount
04/07/2016 (RMW) 31 Gallon Tub (28.00 Lbs) 1.00 $30.000 $30.00
04/07/2016 (RMW) 31 Gallon Tub (26.50 Lbs) 1.00 $30.000 $30.00
04/07/2016 (RMW) 31 Gallon Tub (34.50 Lbs) 1.00 $30.000 $30.00
04/07/2016 (RMW) 31 Gallon Tub (29.00 Lbs) 1.00 $30.000 $30.00
04/07/2016 (RMW) 31 Gallon Tub (37.00 Lbs) 1.00 $30.000 $30.00
04/07/2016 Flat rate for first 8 RMW cont(s). 1.00 $240.000 $240.00
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