HomeMy WebLinkAbout304684 10/31/16 y d..4AA,y
CITY OF CARMEL, INDIANA VENDOR: 366244
jl ONE CIVIC SQUARE MEDASSURE CHECK AMOUNT: $'*"""'390.00•
CARMEL, INDIANA 46032 920 E COUNTY LINE ROAD CHECK NUMBER: 304684
9�"ifgN'c�. SUITE 102 CHECK DATE: 10131/16
LAKEWOOD NJ 08701
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 W25439 390.00 OTHER EXPENSES
VOUCHER # 166410 WARRANT # ALLOWED
366244 IN SUM OF $
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Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
W25439 01-736H-08 390.00
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 10/18/2016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/18/201( W25439 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.
_ 920 E County Line Rd
09/22/2016 W 25439
Suite 102
LJI Lakewood,NJ 08701 Terms Due Date
(732)363-7444
billing@medassureservices.com Net 30 10/22/2016
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#:8324-09-21-2016-531714-B
SIC# Tax Exempt ID# Balance Due Enclosed
$390.00
PO Number# Ship Date Ship Via
09/22/2016 MedAssure
Date Description Cont.Count Weight Unit Price Amount
09/22/2016 Manifest# 8324-09-21-2016-531714-9
31 Gallon Tub(RMW) 5 155 $30.00 $150.00
Flat rate for first 8 RMW cont(s). $240.00 $240.00
Please detach and return bottom portion with check
PLEASE MAKE NOTE OF OUR NEW MAILING ADDRESS.ALL PAYMENTS SHOULD BE MADE TO THE FOLLOWING ADDRESS:
PLEASE REMIT ALL PAYMENTS TO: CUSTOMER NAME&ADDRESS: Sub Total $390.00
MedAssure Carmel Household Hazardous Waste
920 E County Line Rd 30 West Main
Suite 102 Carmel,IN 46032 Tax NA
Lakewood,NJ 08701
(732)363-7444 Total Due $390.00
billing@medassureservices.com
Payment
INVOICE#:W 25439
Balance Due $390.00