307514 01/25/17 (9, )
CITY OF CARMEL, INDIANA VENDOR: 146900
INDIANA DEPT OF ENVIRONMENTAL M"ECK AMOUNT: $kM.r+«w 200.00ONE CIVIC SQUARE 100 N SENATE AVENUE CHECK NUMBER: 307514
CARMEL, INDIANA 46032 ROOM 1255 CHECK DATE: 01125117
INDIANAPOLIS IN 46204-2251
DESCRIPTION
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT OTHER FEES & LICENSES
237262 100.00
1125 4358300 237455 100.00 OTHER FEES & LICENSES
1125 4358300
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%' INVOICE
Please Remit To: Page: 1
INDIANA DEPT.OF ENVIRONMENTAL MANAGEMENT Invoice No: 000237262
PO BOX 3295 Invoice Date: 01/11/2017
INDIANAPOLIS IN 46206-3295 Customer Number: CST100026885
Bill Type: 062
Payment Terms: NET 60
Due Date: 03/12/2017
Bill To:
CARMEL CLAY PARKS&RECREATION
MSAUDREY KOSTRZEWA-FLOWING WELL AMOUNT DUE: 100.00 USD
1411 EAST 116TH STREET
CARMEL IN 46032
Amount Remitted
Note Address Changes Above Email Address:
Write the invoice number on your check and return the upper portion of this invoice.
For billing questions, please email us at WATER@IDEM.IN.GOV
Line Ad' Identifier Description Quantity UOM Unit Amt Net Amount
1 17-IN2290801T-0 PWS Fee - GW 1.00 EA 100.00 100.00
- Accounts Receivable is accepting payments online by e-Check, Master Card or Visa. Please visit
www.IN.gov/IDEM. Under Online Services, click Online Payment Options and follow the prompts.
-You may also call us at 317-234-3099 and follow the instructions for Master Card or Visa payments.
-A processing fee of $1 plus 2% will be charged for credit card payments. A processing fee of $1.00
will be charged for eCheck payments.
- This annual fee billing is required for active Public Water Systems (to defray the costs of
administering activities of the federal Safe Drinking Water Act) under Indiana Code: IC 13-18-20.5.
To view via the internet, visit:
- http://www.IN.gov/legislative/ic/code/titlel3/ar18/ch2O.5.html
- Fees are based on the activity status as of December 31 of the previous year.
- Fees on Transient Non-Community Water System will be based on the type of water system on record
by December 31 of the prior year.
- Fees are not pro-rated. If a system is sold or inactivated during the billing year, the amount of
the assessed fee remains due and payable.
If payment of the assessed fee amount imposes an undue burden on the public water system, the
facility may notify this Agency within forty-five (45) days of this invoice date to pay in four
equal installments within a year.
- Payments not received or received after the DUE date are subject to a delinquency charge equal to
10% of the assessed fee. The complete fee payment or the 1st installment is due within 60 days of
the date of this invoice.
- If several invoices are to be paid by one check, you MUST INCLUDE A COPY OF EACH BILLING INVOICE
in order to ensure proper credit for each fee assessment.
-- For questions regarding your assessed fee amount, please contact Carol Guidry in the Office of
Water Quality at (317) 232-8472 or e-mail cguidry@idem.in.gov.
-IDEM may pursue enforcement action for non payment of annual fees.
TOTAL AMOUNT DUE: 100.00
Please write the invoice number on your check and return the upper portion of this invoice with remittance.
JAN 1 J 2017
--
495-IDEM Printed on Recycled Paper original
� Z
INVOICE
Please Remit To: Page: 1
INDIANA DEPT.OF ENVIRONMENTAL MANAGEMENT Invoice No: 000237455
PO BOX 3295 Invoice Date: 01/11/2017
INDIANAPOLIS IN 46206-3295 Customer Number: CST100026885
Bill Type: 062
Payment Terms: NET 60
Due Date: 03/12/2017
Bill To:
CARMEL CLAY PARKS&RECREATION
MR MICHAEL KLITZING-SPLASH PAD AMOUNT DUE: 100.00 USD
1411 EAST 116TH STREET
CARMEL IN 46032
Amount Remitted
❑ Note Address Changes Above ❑ Email Address:
Write the invoice number on your check and return the upper portion of this invoice.
For billing questions, please email us at WATER@IDEMAN.GOV
Line Ad' Identifier Description Quantity UOM Unit Amt Net Amount
1 17-IN2290053T-0 PWS Fee - GW 1.00 EA 100.00 100.00
- Accounts Receivable is accepting payments online by e-Check, Master Card or Visa. Please visit
www.IN.gov/IDEM. Under Online Services, click Online Payment Options and follow the prompts.
-You may also call us at 317-234-3099 and follow the instructions for Master Card or Visa payments.
-A processing fee of $1 plus 2% will be charged for credit card payments. A processing fee of $1.00
will be charged for eCheck payments.
- This annual fee billing is required for active Public Water Systems (to defray the costs of
administering activities of the federal Safe Drinking Water Act) under Indiana Code: IC 13-18-20.5.
To view via the internet, visit:
- http://www.IN.gov/legislative/ic/code/titlel3/arl8/ch2O.5.html
- Fees are based on the activity status as of December 31 of the previous year.
- Fees on Transient Non-Community Water System will be based on the type of water system on record
by December 31 of the prior year.
- Fees are not pro-rated. If a system is sold or inactivated during the billing year, the amount of
the assessed fee remains due and payable.
- If payment of the assessed fee amount imposes an undue burden on the public water system, the
facility may notify this Agency within forty-five (45) days of this invoice date to pay in four
equal installments within a year.
- Payments not received or received after the DUE date are subject to a delinquency charge equal to
10% of the assessed fee. The complete fee payment or the 1st installment is due within 60 days of
the date of this invoice.
- If several invoices are to be paid by one check, you MUST INCLUDE A COPY OF EACH BILLING INVOICE
in order to ensure proper credit for each fee assessment.
-- For questions regarding your assessed fee amount, please contact Carol Guidry in the Office of
Water Quality at (317) 232-8472 or e-mail cguidry@idem.in.gov.
-IDEM may pursue enforcement action for non payment of annual fees.
TOTALAMOUNT DUE: 100.00
Please write the invoice number on your check and return the upper portion of this invoice with remittance.
R R f,7;�`'�
J Y R J
JAN 1 3 2011
BY:
495-IDEM Printed on Recycled Paper 3 Original