HomeMy WebLinkAbout332836 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
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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
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Amount:Due: $39 USD . .
https://www.jotform.com/invoice?u=Backflow&id=2018-06-18_00:15:41 1/1
11/19/2018 Invoice
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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
_- - -
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Amount Due: $39 USD
https://www.jotform.com/invoice?u=Backflow&id=2018-07.-18_00:16:34. 1/1
jJ11/19/2018- Invoice
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Invoice
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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::
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- $39`USD
Amount:Due: $39 USD
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11/19/2018 Invoice-
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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
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Amount Due: $39 USD
https://www.jotform.com/invoice?u=Backflow&id=2018-09-18_00:18:28 1/1
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JotForm Inc.
Date Invoice.#
111 Pirie St, Ste 1815, c ®-cCoger-18th;201=$+ 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
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Amount'Due: $39 USD .:
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.
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