HomeMy WebLinkAbout330602 10/02/18 ^% ��p''� CITY OF CARMEL, INDIANA VENDOR: 372822
ONE CIVIC SQUARE JAMES M DIBLASIO CHECK AMOUNT: $********50.00*
s9� j�� CARMEL, INDIANA 46032 3813 DONA CT CHECK NUMBER: 330602
MUTON�. CARMEL IN 46033 CHECK DATE: 10/02/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
250 4350900 50.00 OTHER CONT SERVICES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor# 372822 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
JAMES M DIBLASIO IN SUM OF$ CITY OF CARMEL
3813 DONA 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, IN 46033
Payee
$50.00
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 $50.00 I hereby certify that the attached invoice(s),or 9/24/18 0 Rain Barrel Cost Share $50.00
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
20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
CITY OF CARMEL RESIDENTIAL i
RAIN BARREL COST SHARE APPLICATION
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:
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APPLICANT EMAIL ADDRESS: APPLICANT MAILING,ADDRESS:
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PROPERTY ADDRESS:
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PROPERTY UTILITY ACCOUNT NUMBER: NUMBER OF RAIN BARRELS FOR COST SHARE:
RIGHT OF ENTRY
Upon approval of this appliication,the applicant agrees to give the City of Cannel 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 wat�y cost share.Denial of this right will result in the denial of the cost share
application. Applicant's Initials-
Applicant
nitials
Applicant Signature: Date:
R aired attachments for the Residential Cost Share:
_Photo of Each Installed Rain Barrel(Show connection to downspout in photos)
Receipts
4AW-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
CITY OF CARMEL RESIDENTIAL
RAIN BARREL COST SHARE APPLICATION
For Department of Storm Water Management Use
DATE RECEIVED: RECEIVED BY:
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Target Area: ;X APPROVED ..
COOL CREEK WATERSHED''
COST SHARE AMOUNT.
_CARMEL CREEK WATERSHED
DENIED(Reason)
STAFF SIGNATURE: DATE:
2
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\ \2James Di Blasio
3813 Dona Ct
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Carmel 46033-4431
Receipt
Name: � v Amount: Rign
Paid: Check# Cash C Rain Barrel#: 011
Signature: Date: