330608 10/02/18 CITY OF CARMEL, INDIANA VENDOR: 372820
ONE CIVIC SQUARE LARRY J KANE CHECK AMOUNT: $********75.00*
CARMEL, INDIANA 46032 11268 WILLIAMS CT CHECK NUMBER: 330608
9y�roN�O` CARMEL NC 46033 CHECK DATE: 10/02/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
250 4350900 75.00 OTHER CONT SERVICES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor# 372820 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
LARRY J KANE IN SUM OF$ CITY OF CARMEL
11268 WILLIAMS CT 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, NC 46033
Payee
$75.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Engineering
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
0 43-509.00 $75.00 1 hereby certify that the attached invoice(s),or 9/24/18 0 Rain Barrel 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, September 26,2018
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
120
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
4
CffY OF CARMEL RESIDENTIAL
BRAIN BARBEL COST SHARE APPLICAMN
Carmel residential property owners are eligible to receive$50 cost share per rain barrel installed or$75
cost share per barrel installed in a targeted watershed. Cost share not to exceed$375.
APPLICANT NAME: APPLICANT PHONE NUMBER:
APPLICANT EMAIL ADDRESS: APPLICANT MAILING ADDRESS:
�
L a`�� Coate �G� p
�n
PROPERTY ADDRESS: .
PROPERTY UTILITY ACCOUNT NUMBER: NUMBER OF RAIN BARRELS FOR COST SHARE:
e 3 7/7!5--:;-
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 storm water cost share.Denial of this right will result in the denial of the cost share
application. licant's Initials: �J K
Applica Si lure: 3 Date:
pf��
(Required attachments for the Residential Cost Share:
Photo of Each installed Rain Barrel(Show connection to downspout in photos)
f- Receipts
W-9 Form
Submit application and attachments to:
By Mail:
City of Carmel
By Email: Engineering Department
stormwater@carmel.in.gov Attn:Department of Storm Water(Management
1 Civic Square
Carmel,IN 46032
1
T!� CITY OF CARMEL RESIDENTIAL I
RAIN BARREL COST SHARE APPUCATOON
-R S
For Department of Storm Water Management Use
DATE RECEIVED: RECEIVED BY:
1
s�
Tar et Area: APPROVED '
.COOL CREEK WATERSHED COST-SHARE AMOUNT
CARMEL CREEK WATERSHED
_DENIED(Reason)
STAFF SIGNATURE: DATE:
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