HomeMy WebLinkAbout333311 12/11/18 CITY OF CARMEL, INDIANA VENDOR: 229400
� �• ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURI-AHECK AMOUNT: $*******240.00*
s9` ja CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY-FISCAL OFFIC CHECK NUMBER: 333311
302 W WASHINGTON ST,RM E221 CHECK DATE: 12/11/18
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4239099 240.00 73424111292018
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
VOUCHER NO. WARRANT NO.
An invoice of bill to be properly itemized must show;kind of service,where performed,dates service rendered,by
Vendor# 229400 Allowed 20_ whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
Indiana Department.of Homeland Security Payee
................
302 W Washington St., Rm E221 In Sum of$ Purchase Order#
Indianapolis, IN 46204 229400 Indiana Department of Homeland Security Terms
24�.�� i5C1: QE#kElt Date Due
.................
302 W Washington St.,Rm E221
ON ACCOUNT OF APPROPRIATION FOR Indianapolis,IN 46204
109-Monon Center
PO#ornvolce Description
Dept# INVOICE NO. ACCT#/TITLE AMOUNT Invoice Date Number (or note attached invoice(s)or bill(s)) PO* Amount
1093 73424111292018 4239099 $ 240.00 Board Members 11/29/18 73424111292018 Annual Elevator Permits 2019 52221 $ 240.00
1 hereby certify that the attached invoice(s),or
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
$ 240.00 Total $ 240.00
December 6,2018
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
Cost distribution ledger classification if with IC 5-11-10.1.6
claim paid motor vehicle highway fund Signature 20
Accounts Payable Coordinator Clerk-Treasurer
Title
J, i_ ELEVATOR OPERATING CERTIFICATE INVOICE
CARMEL CLAY PARKS & RECREATION 1411 E 116TH ST ACCOUNTS PAYABLE CARMEL IN 46032
1.If Code = * An annual test report is due before a permit is issued.
2.If Code = # A 5 year Test report is due before a permit is issued.
3.0ver due fees must be paid before a permit is issued.
If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE
AFFIRMATION" form.
State No.Code Due Over Due Location Address
111704 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 46032
111978 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL - IN 46032
RID
DEC 0- 3 2010
BY...
Reference Number Invoice Date Please submit ENTIRE document with payment
rte.._
734241-11292018 - 1 11/29/2018 Unit(s) 2 T,o_ta,l Due"upon receipt ,.'
of 2240.00 of $ 240.00
Owner Id 734241 A
Ref.Num. :734241711292.0.18 /- 1 $240 of $ 240.00 Invoice Date 11/29/2018
If Paying by check, include a check made payable to the Department of Homeland security You can pay all your
payments online at IDHS web site https:C oas. hain.gov73fbe/eelev` or7s`ta eE:'do
af —wiEh Visa/Master Card/Discover
cards. Use Owner Id on this letter or State Number on the invoice to-pullwuprinformation-when-paying.-the-duee�
online 9R„complete_the following information and return b mail �ndiana Department of Homeland Security,
Fiscal Department, 302 W.Washington St., Rm : E221,Indianapolis, IN 462b4 or fax to (317)232-6609. Questions?
calr(317)"23"2=64'27 or"E=mai,s-elevator-invoiceodhe.in ggov-2 225%--convenience-fee charged on all credit card
payments.
Full Name on Credit Card
Billing Address: Street
City State Zip Code
CC type:Visa/Am.Express/Discover/Master Card ONLY (circle one)
Acct. Number Exp.Date (mm/yy)
CVV2 Number Contact Phone Number Signature
By signing, cardmember agrees to the obligations set forth by the Cardmember's j
Agreement with the issuer.