HomeMy WebLinkAbout323343 03/23/18 CITY OF CARMEL, INDIANA VENDOR: 362497
ONE CIVIC SQUARE DEPARTMENT OF HOMELAND SECURITVHECK AMOUNT: $"""`*120.00"
. ? CARMEL, INDIANA 46032 BOILER AND PRESS.VALVE SAFETY DIV CHECK NUMBER: 323343
302 W WASHINGTON ST,RM 246 CHECK DATE: 03/23/18
_ INDIANAPOLIS IN 46204-2739
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER' AMOUNT DESCRIPTION
1110 4350100 7675030120.11$ : 120.00 BUILDING REPAIRS & MA
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 362497 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
DEPARTMENT OF HOMELAND SECURITY IN SUM OF$ CITY OF CARMEL
BOILER AND PRESS.VALVE SAFETY DIV An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
302 W WASHINGTON ST, RM 246 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46204-2739
Payee
$120.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Carmel Police 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
7675-03012018-1 43-501.00 $120.00 1 hereby certify that the attached invoice(s),or 3/9/18 7675-03012018-1 elevator operating certificate $120.00
1110 101 1110 101
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
Tuesday, March 13,2018
Jim Barlow
Chief
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
ELEVATOR OPERATING CERTIFICATE INVOICE
CITY OF CARMEL ONE CIVIC SQUARE CARMEL IN 46032
1.If Code = * An annual test report is due before a permit is issued.
2.If Code = # A 5 year Test report is due before a permit is issued.
3.Over due fees must be paid before a2ermit is issued.
If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE
AFFIRMATION" form.
State No.Code Due Over Due Location Address
45581 $120.00 $ 0.00 3 CIVIC SQ, CARMEL IN 46032
Reference Number Invoice Date Please submit ENTIRE document with payment
7675-03012018 -1 03/01/2018 Unit(s) 1 Total Due upon receipt
of 1 $ 120.00 of $ 120.00
Owner Id 7675
Ref.Num. :7675-03012018 - 1 $120 of $ 120.00 Invoice Date 03/01/2018
If Paying by check, include a check made payable to the Department of Homeland security. You can pay all your
payments online at IDHS web site https://oaa.dhe.in.g6v dfbe idhaFeesFines etart.d-o with Visa Master
Card/Discover cards. Use Owner Id on this letter or State Number on the invoice to pull up information when
paying the dues online.OR complete the following information and return by mail :Indiana Department of
Homeland Security, Fiscal Department, 302 W.Washington St., Rm : E221,Indianapolis, IN 46204 or fax to
(317)233-0401. Questions? call(317)232-6427 or E-mail:elevator-invoice®dhs.in.gov 2.25% convenience fee
charged on all credit card payments.
Full Name on Credit Card
Billing Address: Street
City State Zip Code
CC type:Visa/Am.Express/Discover/Master Card ONLY (circle one)
Acct. Number Exp.Date (mm/yy)
CVV2 Number Contact Phone Number Signature
By signing, cardmember agrees to the obligations set forth by the Cardmember's
Agreement with the issuer.
Ref.Num. :7675-03012018 -1 $120 of $ 120.00 Invoice Date 03/01/2018