HomeMy WebLinkAbout320694 01/11/18 4+ufCgpMff
CITY OF CARMEL, INDIANA VENDOR: 074600
y; ® ONE CIVIC SQUARE DEPT OF NATURAL RESOURCES CHECK AMOUNT: $*******200.00*
+ CARMEL, INDIANA 46032 DIVISION OF WATER CHECK NUMBER: 320694
402 W WASHINGTON ST W264 CHECK DATE: 01/11/18
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION.
601 5023990 2018 200.00 OTHER EXPENSES
VOUCHER NO. 173788 WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev 1995)
ALLOWED 20
Vendor # 74600 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER-
DEPT OF NATURAL RESOURCES CITY OF CARMEL
DIVISION OF WATER An invoice or bill to be properly itemized must show: kind of service,where performed,
402 W WASHINGTON ST W264 dates service rendered, by whom, rates per day, number of hours, rate per hour,
INDIANAPOLIS, IN 46204-2641 numbers of units, price per unit, etc.
Payee
200.00 74600 Purchase Order No.
ON ACCOUNT OF APPROPRATION FOR DEPT of NATURAL RESOURCES Terms
Carmel Water Utility DIVISION OF WATER - Due Date
BOARD MEMBERS 402 W WASHINGTON ST W264
I hereby certify that that attached invoice(s), INDIANAPOLIS,IN 46204-2641
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 DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
2018 01-6040-03 $100.00 and received except 1/3/2018 2018 $100.00
2018 01-6040-05 $100.00 1/3/2018 2018 $100.00
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and 1 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
� a APPLICATION FOR WATER WELL DRILLING LICENSE Return to:
1� AND PUMP INSTALLER LICENSE INDIANA DEPA RTMENT OF
DIVISIONOF WATER NATURAL RESOURCES
State Form 417(R3/i t-10) 402 W.Washington St.,Room W264
Approved by State Board of Accounts,2010 Indianapolis,IN 46204-2641
The provisions of IC 25-39 require anyone who operates water well drilling or driving equipment and engages in the drilling of
water wells, or the installation or service of water well pumping equipment in Indiana to have a valid Indiana Water Well
Drilling or Pump Installer License. To qualify for an Indiana water well drilling license or pump installer license, an applicant
must be at least eighteen (18) years of age, successfully complete a competency examination, and provide three reference
statements to the Division of Water, of which at least two must be from a licensed water well driller/pump installer or a
licensed plumber. (IC 25-39-3-3).
Full Name:
(First) (Middle) (Last)
Business Address:
(Street or Rural Route)
(City) / (State) (ZIP code)
Office Telephone Number: 3/T 73�-Z��� Email Address:6W-7s�4r��i'rc/.ia.�dd
(Include area code)
Date of Birth:
Type(s) of Equipment Operated or Installed: e
Number of Years Operated: /7
Employment History (as a water well driller or pump installer):
Company Name ll / Company Address Employment Dates
The annual fee for a water well drilling/pump installer license is one hundred dollars ($100) for a calendar year; whether it is
for one or both endorsements. Please make your check or money order payable to the DEPARTMENT OF NATURAL
RESOURCES (or simply DNR).
I hereby swear or affirm under the penalties for perjury that the information submitted herewith is, to the best of my know-
ledge and belief, true, accurat , and complete.
Signature: Date: -1.2- 7-2-el )
Name of Comp y: 4e049!5-11*'
Note: An application for an original license is not complete until three(3)reference statements are completed and received by the Division of Water.
FOR ADMINISTRATIVE USE ONLY
Date Application Was Received: Application No.:
License Number Issued: Issued By:
SSE iq,p
APPLICATION FOR WATER WELL DRILLING LICENSE Return to:
" AND PUMP INSTALLER LICENSE INDIANA DEPARTMENT OF NATURAL RESOURCES
DIVISION OF WATER
e By d State Form 417(R3/11-10) 402 W.Washington St.,Room W264
Approved by State Board of Accounts,2010 Indianapolis,IN 46204-2641
The provisions of IC 25-39 require anyone who operates water well drilling or driving equipment and engages in the drilling of
water wells, or the installation or service of water well pumping equipment in Indiana to have a valid Indiana Water Well
Drilling or Pump Installer License. To qualify for an Indiana water well drilling license or pump installer license, an applicant
must be at least eighteen (18) years of age, successfully complete a competency examination, and provide three reference
statements to the Division of Water, of which at least two must be from a licensed water well driller/pump installer or a
licensed plumber. (IC 25-39-3-3).
Full Name: .`��hl� j'l O/tNmis6arl'
(First) (Middle) (Last)
Business Address: -6 �d W y S� �
(Street or Rural Route)
(City) (State) (ZIP code)
Office Telephone Number: 7 3 3 —X9'5-6— Email Address: Q
(Include area code)
Date of Birth:
Type(s) of Equipment Operated or Installed:
Number of Years Operated:
Employment History (as a water well driller or pump installer):
Company Name Company Address Employment Dates
The annual fee for a water well drilling/pump installer license is one hundred dollars ($100) for a calendar year; whether it is
for one or both endorsements. Please make your check or money order payable to the DEPARTMENT OF NATURAL
RESOURCES (or simply DNR).
I hereby swear or affirm under the penalties for perjury that the information submitted herewith is, to the best of my know-
ledge and belief, true,5pQyrate, and complete.
Signature: -�'G��/ Date: �z 7
Name of Company:
Note: An application for an original license is not complete until three(3)reference statements are completed and received by the Division of Water.
FOR ADMINISTRATIVE USE ONLY
Date Application Was Received: Application No.:
License Number Issued: Issued By:
Division of Waterer arLc
Attn: Vanessa Gonzalez Q �.
.DNR 402 W.Washington St., W264 �Z
Indiana Department of Indianapolis, IN 46204-2641ay
Natural Resources Toll-free (877) 928-3755
aN aF Y7
RENEWAL OF INDIANA WATER WELL DRILLING & PUMP INSTALLER LICENSES FOR 2018
—A Reminder for All Well Drillers & Pump Installers Who Operate in Indiana—
It is time to renew your Indiana water well drilling and/or pump installer license, or the licenses for drillers or
installers you employ, for the calendar year 2018. 2017 licenses are valid until December 31, 2017 Although
there is no penalty for sending in a 2018 renewal application and fee after December 31st, please note that a cur-
rent 2018 license is required before installing any wells or pumping equipment on or after January 1,2018.
CHECK THE DATE on your license—see below if your most recent license expired in **2016 **
Application forms for renewal are enclosed. If you need additional copies, please copy the form or-download it
from the Division of Water website at: http://www.in.gov/dnr/water/2450.httn
• The signed application form is required for renewal, but license renewals do not require reference
statements or employment histories.
• Please send the application form with a check or money order payable to Indiana DNR for the one-year
renewal fee of$100.00 to the address shown at the top of the page.
• The fee of$100.00 is the same for a well driller only, pump installer only,or a combination license.
• DNR must receive both the form and the fee in order to issue an updated license.
• The fee is not pro-rated for licensing during only part of the year.
• Cash or credit card is acceptable for payment in person at the DNR Customer Service Center at the Indiana
Government Center South(see the address above).
**Did your most recent license expire December 31, 2016?**
An individual with a 2016 license who has not renewed it for 2017, but wants to remain licensed in the future has
until December 31, 2017 to apply&pay for the 2017 license before it is considered lapsed. If you do not obtain a
license for 2017, you cannot later renew your licensed status for 2018 simply by paying the fee. When more than
one year passes before you renew an expired license,you must re-take the written competency examination
in order to be re-licensed.
You may not avoid obtaining continuing education by allowing your license to lapse, and then re-testing.Proof of
earned hours for the year they were due will still be required.
Avoid any inconvenience! Keep your license and continuing education up to date!
When your address changes=If your company changes its name, address, or phone,please notify the Division at
317-232-4160, Option 4. Also,please advise the Division if a licensee you employ leaves the company, and please
advise the licensee to provide a new address to the Division. Renewal reminders cannot be sent to unknown
addresses.
ATTENTION ALL WATER WELL DRILLERS AND PUMP INSTALLERS!
Continuing education hours will not be due until the end of the current two year education cycle on
December 31,2018—Don't wait until the last minute.
See the listing of available approved Continuing Education courses on the Division of Water website at:
http://www.in.gov/dnr/Water/61 10.htm
2018 Indiana Competency Exam Schedule: February 9th April 6th June 15 August 10
Division'of Water � Nq
DNR Attn: Vanessa Gonzalezw `
402 W. Washington St., W264 c1
Indiana Department of
Indianapolis, IN 46204-2641 "`
Toll-free (877) 928-3755 Fay.
Natural Resources
RENEWAL OF INDIANA WATER WELL DRILLING & PUMP INSTALLER LICENSES FOR 2018
—A Reminder for All Well Drillers & Pump Installers Who Operate in Indiana—
It is time to renew your Indiana water well drilling and/or pump installer license, or the licenses for drillers or
installers you employ, for the calendar year 2018. 2017 licenses are valid until December 31, 2017 Although
there is no penalty for sending in a 2018 renewal application and fee after December 31 st, please note that a cur-
rent 2018 license is required before installing any wells or pumping equipment on or after January 1,2018.
CHECK THE DATE on your license—see below if your most recent license expired in **2016 **
Application forms for renewal are enclosed. If you need additional copies, please copy the form or download it
from the Division of Water website at: http://www.in.gov/dnr/water/2450.httn
• The signed application form is required for renewal, but lic not re uire e erence
tatements or emplo met ' t
• ease send the application form with a check or money order payable to Indiana DNR for the one-year
renewal fed of$1.00.00 to the address shown at the top of the page.
• e ee or a we driller only, pump insta er on y, o ion rcense.
• DNR must receive both the form and the fee in order to issue an updated license.
• The fee is not pro-rated for licensing during only part of the year.
• Cash or credit card is acceptable for payment in person at the DNR Customer Service Center at the Indiana
Government Center South(see the address above).
**Did your most recent license expire December 31, 2016?**
An individual with a 2016 license who has not renewed it for 2017, but wants to remain licensed in the future has
until December 31, 2017 to apply &pay for the 2017 license before it is considered lapsed. If you do not obtain a
license for 2017, you cannot later renew your licensed status for 2018 simply by paying the fee. When more than
one year passes before you renew an expired license,you must re-take the written competency examination
in order to be re-licensed.
You may not avoid obtaining continuing education by allowing your license to lapse, and then re-testing. Proof of
earned hours for the year they were due will still be required.
Avoid any inconvenience! Keep your license and continuing education up to date!
When your address changes—If your company changes its name, address, or phone,please notify the Division at
317-232-4160, Option 4. Also, please advise the Division if a licensee you employ leaves the company, and please
advise the licensee to provide a new address to the Division. Renewal reminders cannot be sent to unknown
addresses.
ATTENTION ALL WATER WELL DRILLERS AND PUMP INSTALLERS!
Continuing education hours will not be due until the end of the current two year education cycle on
December 31,2018—Don't wait until the last minute.
See the listing of available approved Continuing Education courses on the Division of Water website at:
http://,vww.in.gov/dnr/water/6110.htm
2018 Indiana Competency Exam Schedule: February 9th April 6th June 15 August 10