HomeMy WebLinkAbout320350 01/04/18 CITY OF CARMEL, INDIANA VENDOR: 366244
ONE CIVIC SQUARE MEDASSURE CHECK AMOUNT: $*******240.00*
CARMEL, INDIANA 46032 920 E COUNTY LINE ROAD CHECK NUMBER: 320350
t�iiox`off SUITE 102 CHECK DATE: 01/04/18
LAKEWOOD NJ 08701
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 W58890 240.00 OTHER EXPENSES
VOUCHER NO. 177056 WARRANT NO. ALLOWED 20 Prescribed by State Board of Accounts City Form No.201(Rev 1995)
Vendor # 366244 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER
MEDASSURE CITY OF CARMEL
920 E County Line Road An invoice or bill to be properly itemized must show: kind of service,where performed,
Ste 102 dates service rendered, by whom, rates per day, number of hours, rate per hour,
Lakewood, NJ 08701 numbers of units, price per unit,etc.
Payee
240.00 366244 Purchase Order No.
ON ACCOUNT OF APPROPRATION FOR MEDASSURE Terms
Carmel Wasterwater Utility 920 E County Line Road Due Date
BOARD MEMBERS Ste 102
I hereby certify that that attached invoice(s), Lakewood, NJ 08701
or bill(s)is(are)true and correct and that
PO# ACCT# the materials or services itemized thereon for DATE INVOICE# Description
DEPT# INVOICE# Fund# AMOUNT which charge is made were ordered and DEP-r# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
W58890 01-73611-08 $240.00 and received except 12/29/2017 W58890 $240.00
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. 20--
Clerk-Treasurer
Invoice
MedAssure Date Invoice No.
_ 920 E County Line Rd 11/03/2017 W 58890
-- Suite 102
MEDAssun Lakewood,NJ 08701 Terms. Due Date
(732)363-7444
billing@medassureservices.com Net 30 12/02/2017
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#:8324-11-02-2017-183709-B
SIC# Tax Exempt ID# Balance Due Enclosed
-- — — ----- --- $240A0
PO Number# Ship Date Ship Via
11/03/2017 MedAssure
Date Description Cont.Count Weight Unit Price Amount
11/03/2017 Manifest# 8324-11-02-2017-183709-8
Flat rate for first 8 RMW cont(s). $240.00 $240.00