HomeMy WebLinkAbout301845 08/11/16 4+ur C4q�f
CITY OF CARMEL, INDIANA VENDOR: 370831
44
ONE CIVIC SQUARE TOBY HOLCOMB CHECK AMOUNT: $"""«"'75.00•
CARMEL, INDIANA 46032 140 4TH STREET NW CHECK NUMBER: 301845
9M�rori"�°' CARMEL IN 46032 CHECK DATE: 08/11/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
250 4350900 070616 75.00 OTHER CONT SERVICES
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995)
TOBY HOLCOMB ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
140 4TH STREET NW IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
CARMEL, IN 46032 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$75.00 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Engineering
Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
0 43-509.00 $75.00 1 hereby certify that the attached invoice(s),or 7/6/16 0 Storm Water Credit for Rain Barrel $75.00
2200 250 2200 250
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
ZZ 2�
Tuesday,August.09,2016
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—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Last name First name Street address City Zip E-mail address Contact Phone App Date Cost-Share Target Area Reimbursement Amount Approved or Denied Date
— -
Holcomb Tob 140 4th Street NWS]®Carmel 4 5 L3 28 rtMl—
Submitted far Payment on 7-6 16
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RESIDENTIAL COST-SHARE APPLICATION
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CITY OF CARMEL STORM WATER USER FEE
RESIDENTIAL COST-SHARE APPLICATION U nft
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APPLICATION TYPE: Initial Application Installation Verification
APPLICANT
NAME: APPLICANT PHONE NUMBER:
APPLICANT EMAIL ADDRESS: APPLICANT MAILING ADDRESS:
PROPERTY ADDRESS:
PROPERTY UTILITY ACCOUNT NUMBER: PROPERTY PARCEL NUMBER:
rz "066
C,OSST--SHARE APPLY
_ING FOR:
Rain Barre) tf� � ��°� —Rain Garden
Permeable Surface —Other approved BMP's
RIGHT OF ENTRY
Upon approval of this application,the applicant agrees to give the City of Carmel and authorized
representatives the right to enter the premises without hindrances,and Inspect any practice being
Installed,or that has been installed,to receive a storm wV11ater utility credit. Denial of this right will result In
the lass of the storm water credit. Applicant's Initials a-v'
APPLICANT SIGNATURE: DATE:
Ow
21
Submit application and attachments to: City ofCarmel
Engineering Department
Attn:Department ofStorm water Management
One Civic Square
Carmel,|N46O32
stonnwmter@cormel/n.gov
Required attachments for the Residential Cost-share Incentive
INITIAL APPLICATION ATTACHMENTS INSTALLATION VERIFICATION ATTACHMENTS
—Sketch of Site and Location of BMP(s) _ZPhotos of installation
—Photos of Site Receipts
—Application Fee
For of Storm Management Use
APPLICANT NAME: PROPERTY ADDRESS:
DATE RECEIVED: RECEIVED BY:
TARGET AREA: YAPPROVED
XCOOL CREEK WATERSHED ICOST-SHARE AMOUNT
—REIMBURSEMENT SENT
—DENIED(Reason)
STAFF SIGN ATUR&—_,, DATE-
61
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