Loading...
HomeMy WebLinkAbout325840 05/30/18 CITY OF CARMEL, INDIANA VENDOR: 359016 it ONE CIVIC SQUARE KAREN BREEDLOVE CHECK AMOUNT: $*******273.00* CARMEL, INDIANA 46032 1409 HANNIBAL STREET CHECK NUMBER: 325840 9MiroN"i�. NOBLESVILLE IN 46060 CHECK DATE: 05/30/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 52218 273.00 OTHER EXPENSES VOUCHER NO. 181661 WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev 1995) ALLOWED 20 Vendor# 359016 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER BREEDLOVE, MICHELLE CITY OF CARMEL DISTRIBUTION 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, numbers of units, price per unit,etc. - Payee 273.00 359016 Purchase Order No. ON ACCOUNT OF APPROPRATION FOR BREEDLOVE, MICHELLE Terms Carmel Water Utility DISTRIBUTION Due Date BOARD MEMBERS I hereby certify that that attached invoice(s), ' 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 52218 01-6360-06 $273.00 and received except 5/22/2018 52218 $273.00 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 5/� /2018 Invoice _�- kri Orm Invoice JotForm Inc. Date Invoice# 1750 Montgomery St Nove20173211115 San Francisco- CA 94111 Tax ID: 46-5729519 Bill To Ship To Username: Backflow Username: Backflow Name: City of Carmel Backflow Name: City of Carmel Backflow Email: Backflow@carmcl.in.gov Email: Backflow@car-mel.in.gov Services Total JotForm Silver Monthly. $39 USD Amount Due: $ 9 USD https://www.jotform.com/i nvoice?u=Backfiow&id=2017-11-17_23:15:42 1/1 5/22/2018 Invoice JO tFO1 Invoice JotForm Inc. Date Invoice# 1750 Montgomery St D_ec tuber. Oz2017 20173511117 San Francisco, CA 94111 Tax ID: 46-5729519 Bill To Ship To . Usemame::Backflow Username:.Backflow Name: City of Carmel Backflow Name: City of Carmel Backflow Email: Backflow@carmel.in.gov Email: Backfiow@cannel,.in.gov . Services Total JotForm Silver Monthly $39 USD Amount Due: t3:7USD ' a "JV W https://www.iotform.com/invoice?u=Backflow&id=2017-12-17_23:17:10 1/1 5/22/2018 Invoice 77 Jo tForm Invoke JotForm Inc. Date Invoice# 1750 Montgomery St 80171115 San Francisco, CA 94111 Tax ID: 46-5729519 Bill To . Ship To Username: Backflow Username: Backflow Name: City of Carmel Backflow Name: City of Carmel Backflow Email: Backflow@carmel.in.gov Email: Backflow@caniiel.in.gov Services Total JotForm Silver Monthly $39 USD Amount Due: Q USD u https://www.jotform.com/invoice?u=Backflow&id=2018-01-17_23:15:55 1/1 2018 Invoice :71 J'o tForm Invoice JotForm Inc. Date Invoice# 1750 Montgomery StF._'� 17t , 2018 20180481115 San Francisco, CA 94111 Tax ID: 46-5729519 Bill To Ship To Username:.Backflow Username: Backflow Name:City of Carmel Backflow Name: City of Carmel Backflow Email: Backflow@carmel.in.gov Email: Backflow@carmel.in.gov Services Total JotForm Silver Monthly $39 USD Amount Due: 3LUSD https://www.jotform.com/invoice?u=Backflow&id=2018-02-17_23:15:39 1/1 5/22/2018 Invoice t.' 0frorm Invoice Invoice JotForm Inc. # 1750 Montgomery St Ma, l8t , 20 20181381216 San Francisco, CA 94111 Tax ID: 46-5729519 Bill To Ship To Username:.Backflow Username: Backflow Name: City of Carmel Backflow Name: City of Carmel Backflow Email: Backflow@carmel.in.gov Email: Backflow@carmel.in.gov ; . '.. Services Total JotForm Silver Monthly $39;USD- Amount Due: $39 USD W l� https://www.jotform.com/invoice?u=Backflow&id=2018-05-18_00:16:34 1/1 -5/22/2018 Invoice 7 JotForm Invoice JotForm Inc. Datell Invoice# 1750 Montgomery Stl 18th, �9 20181081216 San Francisco,.CA 94111 Tax ID: 46=5729519 Bill To . . Ship To Username: Backflow Username: Backflow Name: City of Carmel Backflow Name: City of Carmel Backflow Email: Backflow@carmel.in.gov Email: Backflow@carmel.in.gov Services Total JotForm Silver Monthly $39 USD .Amount Due: $39 USD l� https://www.jotform.com/invoice?u=Backflow&id=2018-04-18_00:16:32 1/1 5/22/2018 Invoice Jo tForm Invoke JotForm Inc. Date Invoice# 1750 Montgomery St BVI c �1�$ 20180771224 San Francisco, CA 94111 Tax ID: 46-5729519 Bill To . . . . _ Ship To Username::Backflow Username:.Backflow Name: City of Carmel Backflow Name: City of Carmel Backflow Email: Backflow@carmel.in.gov Email: Backflow@carmel.in.gov Services Total JotForm Silver Monthly, $39 USD Amount Due: $39 USD jp vU https://www.jotforrh.com/invoice?u=Backflow&id=2018-03-18_00:24:45 1/1 f' Virtual Wallet With Performance Spend Statement Forthepedod 10/26/2017 to 11/24/2017 R For 24-hour information,sign on to PNC Bank online Banking MICHELLE BREEDLOVE on pnc.com Primary account number: ---- Account Number: 1 Page 4 of 5 Banking/Check Card Withdrawals and Purchases -continued Date Amount Description 11/14 35.85 POS Purchase Kroger Noblesville 11/15 51.02 POS Purchase Kroger Noblesville 11/16 10.69 1873 Recurring Debit Card Microsoft 800- 642767 11/16 9.99 1873 Debit Card Purchase Google*Game Insight - 11/17 16.74 1873 Debit Card Purchase Taco Bell#23122 11/17 5.99 1873 Debit Card Purchase Google*Ma g.co/helpp: 11/17 23.58 1873 Debit Card Purchase Speedway 05179 10T 11/17 9.00 1873 Debit Card Purchase Eyes By India Carmel 11/20 5.72 1873 Debit Card Purchase Starbucks Store 02664 11/20 20.05 1873 Debit Card Purchase Exxonmobil Noblesvill 1i1►/2Ua 39:00"`�1873-Debit=CardiPurcha"se Jotform Inc. Virtual Wallet With Performance Spend Statement >C, -C�o For the period 11/25/2017 to 12/22/2017 For 24-hour information,sign onto PNC Bank Online Banking MICHELLE.BREEDLOVE on pnc.nom- Primary account number:, Accot _ -continued Page 5 of 6 Banking/Check Card Withdrawals and Purchases -continued Date Amount Description 12/14 10.41 1873 Debit.Card Purchase Exxonmobil Noblesvill 12/14 .99 1873 Debit Card Purchase Google *Googleplaystor 12/18 23.97 1873 Debit Card Purchase Kfc.X314017 Noblesvil 12/18 10.69 1873 Recurring Debit Card Microsoft 800- 642767 12/18 33.55 1873 Debit Card Purchase Speedway 06882 740 12/18 15.67 1873 Debit Card Purchase McDonald's F37453 12/18 8.64 1873.Dehit Card Purchase Kroger Fuel#2970 12/18 50.00 1873 Recurring Debit Card At&T 800- 2882020 Tx 12/18 9.99 1873 Debit Card Purchase Google*Small Giant 12/18 4.63 1873 Debit Card Purchase Starbucks Store 02664 12/'._ 12i - #2957 - 12/18 1.81 1873 Debit Card Purchase Marathon Petro87536 12/18 35.51 1873 Debit Card Purchase Amazon Mktplace Pmts 12„e --- - -- 12/18 -70 --- - 12/18 o.87 1873 Debit Card Purchase Cabela's Retail 068 12/18 31.40 POS Purchase Kroger Noblesville 12/18 24.87 . 1873 Debit Card Purchase Kroger Fuel Ctr #2957 12/19 21.31 1873 Debit Card Purchase Little Caesars 3072 -03 12/19 6.99 1873 Debit Card Purchase Amazon Mktplace Pmts W 12/1_9 39:0.0__1.873QebitCard Purchase_Jotformalnc. 12/19_ 20.00 1873 Debit Card Purchase Westfield Washington S- 12/19 50.00 1873 Debit Card Purchase Amazon.Com Amzn.Com/Bi 12/19 13.64 POS Purchase CVS/Pharmacy#Noblesville 12/19 76.11 POS Purchase CVS/Pharmacy#Noblesville 12/19 38.85 POS Purchase Wal-Mart#0923 Noblesville 12/21 59.98 1873 Debit Card Purchase Amazon Mktplace Pmts W 12/21 145.90 1873 Debit Card Purchase Ossip Optometry 061 Banking/Check Card Withdrawals and Purchases continued on next page P Virtual Wallet With Performance Spend Statement For the period 12123%2017 to 01/25/2018 For24-hourinfonnation,signonto PNC BankOnlineBanking MICHELLE BREEDLOVE on prio.coin Primary account.numbe - I Account Numt continued Page 5 of 6 Banking/Check Card Withdrawals and Purchases -continued Date Amount Description 01/17 1.0.99 1873 Recurring Debit Card Amazonprime Membershi 01/17 20.00 POS Purchase Dollar-General Noblesville 01/18 36.05 1873 Debit Card Purchase Pizza King-82 01/18 31.92 POS Purchase Shell'Service Carmel.ln 01/18 23.97 POS Purchase Shell Service Carmel In 01/18 72.71 POS Purchase Dollar-General Noblesville 01/1.8 17 72 1873-Debit-Card Purchase Culvers Of Indiana OCIL1Gt9- - 39:00:1.873-Debit�Car6P-urchase Jotform Inc. 01/19 15.02 1873 Debit Card Purchase McDonald's M5789 Carm Virtual Wallet With Performance Spend Statement a Fortheperiod 01/26%2018 to 02/22/2018 Ea For24-hourinfonnadon,signonto PNC Bank Online Banking MICHELLEBREEDLPVF an pnc.com Primary account num'. _ Account Number -continued Page 4 of 5 Banking/Check Cana Withdrawals and Purchases continued Date Amount Description 02/12 22.15 POS Purchase R K Oil Corp Noblesville 02/13 20.00 1873 Debit Card Purchase Westfield Washington S 02/13 10.79 POS Purchase Dollar-General Noblesville 02/14 14.99 1873 Debit Card Purchase Amazon Digital Svcs 02/14 1.6.59 POS Purchase Speedway 06882 Westfield In 02/14 10.45 1873 Debit Card Purchase Culvers Of Indiana 02/15 50.00 1873 Debit.Card Purchase Counseling Associates 02/15 7.95 1873 Debit Card Purchase McDonald's F37453 02/15 8.99 1873 Debit.Card Purchase Amazon Digital Svcs 02/15 13.61 POS Purchase Dollar-General Noblesville 02/15 10.69 1873 Recurring Debit Card Microsoft 800- 642767 02/15 15.04 1873 Debit Card Purchase Speedway 05179 10T 02/16 28.55 POS Purchase R K Oil Corp Noblesville 02/20 10.99 1873 Recurring Debit Card Amazonprime Membershi 02/20 8.61 1873 Debit Card Purchase Starbucks Store 02664 02/20 68.86 1873 Debit Card Purchase Scottys:Brewhouse 02/20 103.00 ATM Withdrawal 1717A W University Muncie In 02/20 20.17 1873 Debit Card Purchase Speedway 06065 199 02/20 11.83 POS Purchase R K Oil Corp Noblesville 02/20 52.98 1873 Debit Card Purchase Breakout Games 02/20 6.69 1873 Debit Card Purchase McDonald's F33047 02/20 31.71 1873 Debit Card Purchase Hot Box Pizza- Nobles 02120-z- .39.00_1873-Debit`Card-Purchase Jotform,,nc;_ ®PNC . r ACCOUNT ACTIVITY (Tuesday,May 22,2018) Virtual Wallet wi+h_P�-'--mance Si ba .Overdraft Protected by Reserve MONTHLY TRANSACTIONS SEARCH: Description:jot Date - Description Withdrawal Deposit CategoryBalance May �y 21� DEBIT CARD PURCHASE XXXXX1873 JOTFORM INC.HTTPSWWW.JO CA L3 9T OV e April Apr 19 DEBIT CARD PURCHASE XXXXX1873 JOTFORM INC.JOTFORM.COM CA $39.01) , March - MaDEBIT CARD PURCHASE XXXXX1873 JOTFORM INC.JOTFORM.COM CA 39.Q-0 Transactions older than Feb 23,are located in Online Statements» ©Copyright 2018.The PNC Financial Services Group,Inc.All Rights Reserved. Need-Help?Call us at 1-888-PNC-BANK(762-2265)