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Home My WebLink About333916 12/27/18 y r„Wgy CITY OF CARMEL, INDIANA VENDOR: 372783 I ONE CIVIC SQUARE PEGEX INC CHECK AMOUNT: $*****2,730.00* CARMEL, INDIANA 46032 5520 NOBEL DRIVE CHECK NUMBER: 333916 SUITE 125 CHECK DATE: 12/27/18 FITCHBURG WI 53711 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 18HK2WI1392 2,730.00 OTHER EXPENSES VOUCHER NO. 183679 WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev 1995) ALLOWED 20 Vendor# 372783 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER PEGEX INC CITY OF CARMEL 5520 NOBEL DR An invoice or bill to be properly itemized must show: kind of service,where performed, SUITE 125 dates service rendered, by whom, rates per day, number of hours, rate per hour, FITCHBURG, WI 53711 numbers of units, price per unit,etc. Payee $2,730.00 372783 Purchase Order No. ON ACCOUNT OF APPROPRATION FOR PEGEX INC Terms Carmel Water Utility 5520 NOBEL DR Due Date BOARD MEMBERS SUITE 125 - I hereby certify that that attached invoice(s), FITCHBURG,WI 53711 or bill(s)is(are)true and correct and that PO# ACCT# 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 18HK2WI139 01-6360-04 $2,730.00 and received except 12/20/2018 18HK2WI1392 $2,730.00 2 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. .2Q-- Clerk-Treasurer 'a1 INVOICE PegEx,Inc.I Hazardous Waste Experts ACCOUNT# 11VI-XFF es i 5 5 a p �J D PAYMENT TERMS NET 15 Fitchburg,WI.53711 5 INVOICE DATE 10/02/18 INVOICE# 18HK-2WI-1392 Email:ar@pegex.com PO# Sales Rep:Jonathan Schwid SERVICE DATE 09/27/18 PEGEX JOB# 18HK-2WI CONTACT PERSON .. _, _. . DUE DATE 10/17/18 John Mascari jmascari@carmel.in.gov 317-716-6624 BILLING ADDRESS RICK-LIP ADDRESS City of Carmel Water Utility City of Carmel Water Utility 3450 W 131 st St 5484 E 126th St Carmel,IN 46074 Caramel,IN 46033 USA USA INVOICE DETAILS This invoice represents charges based on the quoted work.There may be supplemental billings or credits for additional or non-conforming waste. Type Description Qty. Units Unit Price Extended Price O'sposal 12,x 30ga)17rums HACH Rolle Rust 12 0 Drurns $140 00 $1 680 00 Remover � Overpacks" Drums and Labor for Overpacking 6.0 Drums $175 00` $1'050.m" Dam iged.Drums.':Estimating:6. Overpacks Disposal Total $2,730.00 Payments $0.00 Credit $0.00 Balance Due in USD "� NON-HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number WASTE MANIFEST 5.Generators.Name and Mailing Address Generator's Site Address(if different than mailing address) Generators Phone: 7 t t'j "N 6.Transporter I Company Name U.S.EPA-ID Number 10 N 0 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name.and,Site Address U.S.EPA ID Number Facili 's Phone: 9.Waste Shipping Name and Description 10.Containers 11.Total 12.Unit No. Type Quantity Wt.Nol. cc 0 Ir rwd— r" r Z.C144 3. Received : Sk,,\ Co": 4. Date : PO # oc( 13. Special Handling Instructions and Additional Information ACCT # Use : . 0,4 dja, O 1fdow, 14.GEN ERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. Generator's/Offeror's PrintedfTypeq,Name Signature Month Pay Year 0 -1 15.Intema t i onal Shipments D Import to U.S. ❑Export from U.S. Pon of entry/exit: Transporter Signature for exports only): Date leaving U.S.: Lu 16.Transporter Acknowledgment of Receipt of Materials Transporter 1 Pdntedrryp6rd,-,Name S X ignaI ure Month Day- Year IL z TrahspCter 2 Printed/Typed Name Signature Month Day Year 17.Discrepancy 17a.Discrepancy Indication Space El Quantity El Type El Residue E]Parfial Rejection 0 Full Rejection Manifest Reference Number: 17b.Altemate Facility(or Generator) U.S.EPA ID Number ILL Facililys Phone: 0 17c.Signature of Alternate Facility(or Generator) uJ Month Day Year z a V5 W 18.Designated Facility Owner or Operator.Certification of receipt of materials covered by the manifest except as noted in Item 17a Printedrryped Name Signature Month Day Year GENERATOR'S/SHIPPER'S INITIAL COPY REFERENCE NO. 101112 PURCHASE ORDER NO. ENVIRONMENTAL t NMENTAL MANAGEMENT, INC. SERVICE DATE WEEK (317)839-9323 FAX: (317)839-9329 WORK ORDER 1-800-BEE-SAFE THIS IS NOT AN INVOICE CUSTOMER LOCATION CUSTOMER SURVEY:www.bee-enviro.us 7- ca 7- j I certify that my total waste streams are within one of the following categories. 0-200 LBS/Month-M4 A \ 220-2200 LBS/Month Greater than 2200 LBS/Month SERVICES Quantity PCode Description Unit Price Service Charge 7 2? j� 3 4 5 6 8 eceived - R D a95 - SHIPPING DES PS H I P P I TN ��S I N of Container antity Unit of �__,r Q HM Descriptio 10,19-A- Containers T a —Measure 5 16 3 55 X UN1203,Gasoline,3,PG 11(RCRA EXEMPT) Used Antifreeze(NOT USDOT OR USEPA HAZARDCA)CCT Used Oil Filters(NOT USDOT OR USEPA HAZARDO�S Used Oil(NOT USDOT OR USEPA HAZARDOUS) I U S 0 UN3291,Regulated Medical Waste,N.O.S.,6.2,PG 11 (NOT DOT or RCRA REG) TOTALS I agree to pay the above charges and to be bound by the teens and conditions set forth above and on the Total Service reverse side of this document.Please charge my account for this transaction unless otherwise indicated in the Total Products received section. The individual signing this document is duly authorized to sign and bind customer to its terms. This is to certify that the above named material are properly classified,packaged,marked and labeled Sales Tax and are in proper condition for transportation according to the applicable regulations of the Department of Transportation. r Total Due Generators Initials Payment Rev li Bee Environmental Management,Inc.,688 Tower Road,Plainfield,IN 46168,Facility TD#INR000124537 Transporter ID Number INR000124537 - Facility Phone(317)839-9323 DATE CUSTOMER (PRINT-).- SIGNATURE -j TRANSPORTER(PRINT) SIGNATURE r fDATE ~Z7 White:Bee Manifest Yellow:Billing Pink:Customer www.bee-envir®. us