HomeMy WebLinkAbout327784 07/20/18 VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 372619 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
VALENTINE J. KLIMKOWSKI IN SUM OF$ CITY OF CARMEL
4504 CAMELOT LANE 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.
CARMEL, IN 46033
Payee
$75.00
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Terms
Engineering
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
0 43-509.00 $75.00 1 hereby certify that the attached invoice(s),or 7/24/18 0 Rain Barrel Residential Cost Share $75.00
2200 250 2200 250
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,July 18,2018
Jeremy Kashman
Director
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
Clerk-Treasurer
Rain Barrel Residential Cost Share
Last name First name Street address City Zip E-mail address Contact Phone App Date Cost-Share Target Area Reimbursement Amt !Approved/Denied Date
Klimkowski Valentine 4504 Camelot Lane Carmel 46033 alaklmMa omail.com 317-9184648 5/30/2018 1 Rain Barrel Yes 1$75 (Approved 7/5/2018 I
Submitted for Payment on 7-5-18 — —
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RESIDENTIAL COST-SHARE APPLICATION
a�Of
fo
`t CITY OF CARMEL STORM WATER USER FEE
RESIDENTIAL COST-SHARE APPLICATIONr�f
APPLICATION TYPE Initial Application _Installation Verification
APPLICANT NAME:Vali r)V, �_y, APPLICANT PHONE NUMBER:
HIirnbows- .i (27,T) q c % -
APPLICANT EMAIL ADDRESS: APPLICANT MAILING ADDRESS:
�(�kl ►��� (�g0, I .� 4G-0 .� ca.,n-c- t d Lam
cd ar-m 1 l N 3
PROPERTY ADDRESS: 4soq Cp,T)^e_l 0+ Laine , Carycel \N 46Q33
PROPERTY UTILITY ACCOUNT NUMBER: PROPERTY PARCEL NUMBER:
0gS0729Q-05 l b-10-32-'a2 OZ-off .GOO
COST-SHARE APPLYING FOR:
Rain Barrel Rain Garden
Permeable Surface _Other approved BMP's
RIGHT OF ENTRY
Upon approval of this application,the applicant agrees to give the City of Carmel and authorized
representatives the right to enter the premises without hindrances,and inspect any practice being
installed,or that has been installed,to receive a stormw�tuti'ty credit. Denial of this right will result in
the loss of the storm water credit. Applicant's Initials
APP 1CANT SIGNATURE: DATE:
W/X)
21
Submit application and attachments to: City of Carmel
Engineering Department
Attn: Department of Storm water Management
One Civic Square
Carmel, IN 46032
stormwater@carmeLin.gov
Required attachments for the Residential Cost-share Incentive
INITIAL APPLICATION ATTACHMENTS INSTALLATION VERIFICATION ATTACHMENTS
Sketch of Site and Location of BMP(s) \�V Photos of Installation
Photos of Site \Receipts
Application Fee
For Department of Storm water Management Use
APPLICANT NAME: PROPERTY ADDRESS:
DATE RECEIVED: RECEIVED BY:
TARGET AREA: APPROVED
�SOOL CREEK WATERSHED RCOST-SHARE
AMOUNT
REIMBURSEMENT SENT
DENIED(Reason)
STAFFSIGNA DATE: �� A
22
Proscribed 6y State Board ofAmounlS - - - -- - -- -` ---------
RECEIPTBoyce Fortes Systems.Dalaville.IN_ General Form No.352(REV.199.0
3 HAMILTON COUNTY SWCD
GENERAL N0. 002513
NOBLESVILLE, IN. DATE - ,20
RECEIVED FROM
THE SUM OF
ON ACCOUNT OF 100
PAYMENTTYPE
AND AMOUNT: / ,/
CASH CHECK ( -/- 2C' M.O. ----?-
E.F.T. C.0 IB.C. OTHER
AUTFrORIZED SIGNATURE
Prescribed by State Board of Accounts _
RECEIPTBoyce Forms Systems,Daleville,IN General Form No.352(REV.1997)
HAMILTON COUNTY SWCD
GENERAL N0. 002512
NOBLESVILLE, IN, DATE 20
RECEIVED FROM 'F�-L'k k1
W
THE SUM OF ��iG� 'y �' uI �
DOLLARS
ON ACCOUNT OF_ !�YI 100
PAYMENTTYPE
AND AMOUNT:
CASH CHECK M.O.
r
E.F.T. C.C./B.C. OTHER AUTHORIZED SIGNATURE
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