318985 11/22/17 • _Cq9.
���` €• CITY OF CARMEL, INDIANA VENDOR: 146900
r I' ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL M"ECK AMOUNT: $......*100.00*
a4 CARMEL, INDIANA 46032 P.O.BOX 3295 CHECK NUMBER: 318985
INDIANAPOLIS IN 46206-3295 CHECK DATE: 11/22/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4341999 253327 100.00 OTHER PROFESSIONAL FE
j''
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 146900 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
INDIANA DEPT OF ENVIRONMENTAL MGT IN SUM OF$ CITY OF CARMEL
P.O. BOX 3295 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46206-3295
Payee
$100.00
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Redevelopment Commission 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
253327 43-419.99 $100.00 1 hereby certify that the attached invoice(s),or 10/31/17 253327 11 and 151st Ave NE $100.00
902 902 902 902
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
Wednesday, November 22,2017
Mestetsky, Henry
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 distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
INVOICE
Please Remit To: Page: 1
INDIANA DEPT.OF ENVIRONMENTAL MANAGEMENT Invoice No: 000253327
PO BOX 3295 Invoice Date: 10/31/2017
INDIANAPOLIS IN 46206-3295 Customer Number: CST100047991
Bill Type: 013
Payment Terms: NET 30
Due Date: 11/30/2017
Bill To:
CARMEL REDEVELOPMENT DEPARTMENT
WILLIAM HAMMER AMOUNT DUE: 100.00 USD
30 WEST MAIN
SUITE 220
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 AIR@ IDEM.IN.GOV
Line Ad' Identifier Description Quantity UOM Unit Amt Net Amount
1 417-177692-214718 11 1st Ave NE 1.00 EA 50.00 50.00
2 417-177693-214719 15 1st Ave NE 1.00 EA 50.00 50.00
- On December 30, 1990, Indiana Rule 326 IAC 14-10-5 became effective which requires IDEM to
quarterly bill the owner or operator who submits asbestos demolition/renovation operation
notifications during the previous quarter.
- Non-payment is a violation of 326 IAC 14-10-05 and may result in enforcement action.
- If you have questions regarding determination of the quarterly bill, please contact Lee Openbrier
in the Asbestos Section at 317-232-8232.
- Please note that the identifier field incorporates IDEM's control number and the notification
number. The description field identifies the facility address of the particular project.
- This invoice is for the Fourth Quarter 2017. This would be for the period beginning July 1
through September 30, 2017.
- Accounts Receivable is accepting payments online by e-Check, Master Card or Visa.
-Please visit www.IN.gov/IDEM. Under Online Services, select Online Payment Options and select Pay
by: eCheck or Pay by: Credit Card. Under Transaction Item, select Invoice Payments 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.
TOTALAMOUNT DUE: 100.00
Please write the invoice number on your check and return the upper portion of this invoice with remittance.
495-IDEM Printed on Recycled Paper Original