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HomeMy WebLinkAbout181948 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: 146900 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENT MGT i t‘-‘. CHECK AMOUNT: $100.00 100 N SENATE AVE l CHECK NUMBER: 181948 r CARMEL, INDI 46032 MC 50 -10C INDIANAPOLIS IN 46204 -2251 CHECK DATE: 2/3/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4340600 000114576 100.00 RECORDING FEES k INVOICE Please Remit To: Page: 1 INDIANA DEPT OF ENVIRONMENTAL MGMT Invoice No: 0001 14576 CASHIER OFFICE MAIL CODE 50 -10C Invoice Date: 01/08/2010 100 NORTH SENATE AVENUE Customer Number: CST100026885 INDIANAPOLIS IN 46204 Bill Type: 062 Payment Terms: NET 60 Due Date: 03/09/2010 Bill To: CARMEL CLAY PARKS RECREATION MS AUDREY KOSTRZEWA- FLOWING WELL AMOUNT DUE: 100.00 USD 1411 EAST 116TH STREET CARMEL IN 46032 10 Amount Remitted Note Address Changes Above For billing questions, please call 317- 232 -8705 Line Adj Identifier Description Quantity UOM Unit Amt Net Amount 1 10- IN2290801T -0 PWS Fee GW 1.00 EA 100.00 103.00 This annual fee billing is required for active Public Water Systems (to defray the costs of administering activities of the federal Safe Drinking Water Act) under Indiana Code: IC 13 -18 -20.5. To view via the internet, visit: http: /www.IN.gov /legislative /ic /code /title13 /ar18 /ch20.5.htm1 Fees are based on the activity status as of December 31 of the previous year. Fees on Transient Non- Community Water System will be based on the type of water system on record by December 31 of the prior year. Fees are not pro rated. If a system is sold or inactivated during the billing year, the amount of the assessed fee remains due and payable. If payment of the assessed fee amount imposes an undue burden on the public water system, the facility may notify this Agency within forty -five (45) days of this invoice date to pay in four equal installments within a year. Payments not received or received after the DUE date are subject to a delinquency charge equal to 10% of the assessed fee. If several invoices are to be paid by one check, you MUST INCLUDE A COPY OF EACH BILLING INVOICE in order to ensure proper credit for each fee assessment. For questions regarding your assessed fee amount, please contact Deborah Glover in the Operations Section, Office of Water Quality at 317 -232 -8472. ATTENTION: The due date shown in the upper right hand corner of this invoice reflects the standard 60 days past the invoice print date. TOTAL AMOUNT DUE 100.00 A copy of your invoice must be included with payment. Purchase Ann Perni.L-/ W Description E: (A0 I1- r 1 -1/AWL wee( P.O. ForF (.J satnvg Budost JAW 1 Z 2010 U Purchaser 111. Approval 495 -IDEM Printed on Recycled Paper Original -�I 4 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. Payee Purchase Order No. 00351805 Indiana Department of Environmental Mgmt Terms Cashier Office Mail Code 50 -10C 100 North Senate Ave Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 1/8110 114578 annual permit for public water flowing well 100.00 Total 100.00 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 20 Clerk- Treasurer Voucher No. Warrant No. 00351805 Indiana Department of Environmental Mgmt Allowed 20 Cashier Office Mail Code 50 -10C 100 North Senate Ave Indianapolis, IN 46204 In Sum of 100.00 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1125 114578 4340600 100.00 I 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 28 -Jan 2010 Signature 100.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund