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Home My WebLink About332836 11/30/18 �/ t� CITY OF CARMEL, INDIANA VENDOR: 359016 { ONE CIVIC SQUARE KAREN BREEDLOVE CHECK AMOUNT: $*******234.00* s_ a' CARMEL, INDIANA 46032 1409 HANNIBAL STREET CHECK NUMBER: 332836 -9M�diori E°'`9 NOBLESVILLE IN 46060 CHECK DATE: 11/30/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 234.00 OTHER EXPENSES VOUCHER NO. 183433 WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev 1995) ALLOWED 20 Vendor# 359016 IN SUM OF$ 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 234.00 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), ' PO# ACCT# or bill(s)is(are)true and correct and that 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 BREEDLOVE 01-6360-06 $234.00 and received except 11/26/2018 BREEDLOVE $234.00 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 11/19/2018 Invoice 1 fi, W-, VVV nvoOt ><ce 7otForm Inc. Date. :_ Invoice:# . : ' 111 Pirie St, Ste 1815, �une.18th O 8 20.181.691215 San Francisco,CA 94111.1 Tax ID: 46-5:72.9519 Bill To. . . .. Ship To Username:Backflow Username:"Backflow Name: City of Carmel Backflow Name: City of Carmel Backflow Email: Backflow@eatmdl.in.gov . Etnail: Backflow@carmel.in.gov.: . . . Services :: Total otF 'm-Silve Monffily- $3�9-USD r Amount:Due: $39 USD . . https://www.jotform.com/invoice?u=Backflow&id=2018-06-18_00:15:41 1/1 11/19/2018 Invoice 'G JO F6 nvo' ice JotFor_m Inc. Date - Invoice# . . Jul li8t� h-20 8 20.181991216 111 Pirie St, Ste-1815, y San Francisco,CA 94111. Tax ID: 46=5:729519 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--- ervices =. Total _- - - QotFxm Silve Mr orithl �" �`--$39 USD: Amount Due: $39 USD https://www.jotform.com/invoice?u=Backflow&id=2018-07.-18_00:16:34. 1/1 jJ11/19/2018- Invoice 0 rForm Invoice 7otForm Inc. Date Invoice:9 . 111 Pirie St, Ste 1815, 7ug7st-a 8th;-20 L8 20.1823 01217 -San Francisco,CA 94111. Tax I1) -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:: =J9onSilver- - - $39`USD Amount:Due: $39 USD https://www.jotform.comfinvoice?u=Backflow&id=2018-08-18_00:17:56 1/1 11/19/2018 Invoice- _ x t r Invoice of orm nc. Date Invoice:# 111 Pirie St, Ste 1815, Sbptem6W1=8th;20'x8 20182611218 San Francisco, CA 94111. Tax ID: 46-5.729519 Bill To -Ship To. . . . . . Username:Backflow Username:Backflow. Name: City of Carmel Backflow Name: City of Carmel Backflow .. Email: Backflow@catmel.in.gov.. Email: Backflow@carrhel.m.gov... Services Total p otEorm Sver Monthly JSil .. - - il Amount Due: $39 USD https://www.jotform.com/invoice?u=Backflow&id=2018-09-18_00:18:28 1/1 ., ,,11/19/2018 Invoice Jo tForm: nv'ice JotForm Inc. Date Invoice.# 111 Pirie St, Ste 1815, c ®-cCoger-18th;201=$+ 20182911215 San Francisco,*CA 94111. Tax ID: 46-5729519 .. Bi11 To Ship To. . . Username: Backflow . Username:Backflow Name: City of Carmel.B:ackflow Name: City of Carmel Backflow ... Email: Backflow@carmel.in.gov. Email: Backflow@carmel'.in.gov-: Services Total 7�otForrn-Silvjr M&nthly= _��__v— ---=- - == - `----$39 USD Amount'Due: $39 USD .: https://wWw.jotform.com/invoice?u=Backflow&id=2018-10-18_00:15:53 1/1 4 ~`N11/19/2018 Invoice: J-0ort� Invoice JotForm Inc. Date Invoice:# . 111 Pirie St, Ste 1815, Hove`rnber�l7�th>2018 20183211116 .. San Francisco;CA 94111_ Tax ID::46=5:72.9519 Bill To Ship To Username:Backflow Username:Backflow . Name: City of Carmel.B.ackflow Name: City of Carmel Backflow Email: Backflow@carmel.in.gov Email: Backflow@cartimel.in.gov.: . Services Total JotForm Silver Monthly' 3IISD l AmountDue: ' $39 USD https://www.jotform.com/invoice?u=Backflow&id=2018-11-17_23:16:28 1/1 Virtual Wallet With Performance Spend Statement Forthe period p5/24/2D78—to=-O6/2� R For 24-hour intormation,sign onto PNC Bank Online Banking MICHELLE BREEDLOVE on pnc.com Primary account number: Page 5 of Account Number: -continued 6 Banking/Debit Card Withdrawals and Purchases continued Date Amount Description 06/15 06/15 06/15 06/15 06/15 06/18 06/18 06/18 06/18 06/18 06/18 06/18 06/18 1.873-Debit-Card=Purchase'Jotform-lnc) Q6/19 06/19 06/19 06%20 06/20 06/21 06/21 06/22 06/25 06/25 06/25 06/25 06/25 06/25 06/25 06/25 06/25 06/25 Virtual Wallet With Performance Spend Statement F ethe,period----06/26/2018—to-07/25/2 8, For 24-hour information,sign onto PNC Bank Online Banking MICHELLE BREEDLOVE on pnc.com Primary account number: Page 5 of Account Number: -continued 6 Banldng/Debit Card Withdrawals and Purchases continued Date Amount Description 07/16 07/16 07/16 07/16 07/16 07/16 07/16 07/16 07/16 07/16 07/16 07/16 07/16 07/17 07/17 07/19 07/19 07/19 X07%19 X9:00– -1873-Debit Card-Purchase Jotform--Inc— 07/19 07/20 07/23 07/23 07/23 07/23 07/23 07/23 07/23 07/24 Banking/Debit Card Withdrawals and Purchases continued on next page Virtual Wallet With Performance Spend Statement For the period07/26/201_.8 too08/23[20�8 For 24-hour information,sign on to PNC Bank Online Banking MICHELLE BREEDLOVE on pnc.com Primary account number: Page 5 of Account Number: -continued 5 Banking/Debit Card Withdrawals and Purchases continued Date Amount Description 08/16 08/17 08/20 08/20 08/20 08/20 f"08/20 – --3_9_:OQ—=1'873 Debit Card,Purchase Jotform..Inc: 08/20 08/20 08/20 08/20 08/21 08/22 08/22 08/22 08/23 08/23 08/23 Online and Electronic Banking Deductions There were 5 Online or Electronic Date Amount Description Banking Deductions totaling 07/26 Web Pmt Single-Resident Polaris Property 105095775 07/30 Direct Payment-Ins.Prem Farm Bureau XXXXXX4854 08/13 Online Transfer To 08/20 Online Transfer To 08/21 Web Pmt Single-Web_pay Duke Energy In 14962881081818 Member FDIC Q Equal Housing Lender Virtual Wallet With Performance Spend Statement For the period(�0'_8%24/2018.---.to-09/24/2018 For 24-hour information,sign onto PNC Bank Online Banking MICHELLE BREEDLOVE on pnc.com Primary account number: Page 4 of 5 Account Number: -continued Banking/Debit Card Withdrawals and Purchases continued Date Amount Description 09/10 09/10 09/10 09/11 09/11 09/11 09/11 09/12 09/12 09%13 09/17 09/17 09/17 09/17 09/17 09/17 09/17 09/17 09/17 09/17 09/18 09/18 09/18 09/18 09/18 __1.873 Debit Card-Purchase Jotform Inc. 09/1-9. - 39:00— _ 09/19 09/19 09/20 09/21 09/21 09/21 09/24 09/24 Banking/Debit Card Withdrawals and Purchases continued on next page Virtual Wallet With Performance Spend Statement For the period[OT125/2018 0/24/2018 Ea For 24-hour information,signonto PNC Bank Online Banking MICHELLE BREEDLOVE on pnc.com Primary account number: 4 Page 4 of Account Number: -continued 5 Banking/Debit Card Withdrawals and Purchases -continued Date Amount Description 10/15 10/16 10/16 10/18 10/18 10/18 10/18 10/19 v-1Q/19 39:00 -8-7-3,Debit_Car_dPurchase-Jotform-Inc. 10/19 10/19 10/22 10/22 10/22 10/22 10/22 10/22 10/22 10/22 10/22 10/22 10/22 10/23 10/23 10/23 10/23 10/23 10/24 10/24 10/24 Online and Electronic Banking Deductions There were 3 Online or Electronic Date Amount Description Banking Deductions totaling 09/28 Direct Payment-Ins.Prem Farm Bureau XXXXXX4854 Online and Electronic Banking Deductions continued on next page PN ACCOUNT ACTIVITW(mM nd s26s'j Virtual Wallet with Performance Overdraft Protected-by Reserve MONTHLY TRANSACTIONS Date Description Withdrawal_ Deposit Category Balance November Pending Nov 17 Pending Nov 17 Pending Nov 17 Pending Nov 17 Pendingr, - Nov 18 $39:00-=� Pending. Nov 18 Nov 16 Nov 16: Nov 15 Nov 15 Nov 14 Nov,14 Nov 13 Nov 13 Nov 13 Nov 13 Nov 13 Nov 13 Nov 13 Nov 13 Nov 9 Nov 9 Nov.9 Nov 9 Nov 9 Nov 7 Nov 7 Nov 7 Nov 7 Nov 7 Nov 6. Nov 6 Nov 6