HomeMy WebLinkAbout181768 02/02/2010 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE
s o CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV CHECK AMOUNT: $9,431.46
io 101 N SENATE AVE CHECK NUMBER: 181768
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 2/2/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4110000 1,560.00 FULL TIME REGULAR
1125 4110000 3,205.41 FULL TIME REGULAR
1201 4110000 1,560.00 FULL TIME REGULAR
1207 4110000 2,411.05 FULL TIME REGULAR
651 5023990 695.00 OTHER EXPENSES
133438 -1
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277
Toll free 1 -800- 891 -6499 Marion County 232-7436
STATEMENT OF BENEFIT CHARGES (FORM 535)
CONFIDENTIAL RECORD PURSUANT TO IC 22.4 -19 -6, IC 4 -1 -66
Page 1
CITY OF •CARMEL ACCOUNT/
ATTN CLERK TREASURER LOCATION NUMBER 133438 000
ONE' C I U I C S Q REPORTING MONTH DEC 2009
CARMEL IN W6032 -2584
NET CHARGES $9,428.46
POSTING DATE JAN-08, 2010
The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for
unemployment insurance since, before any payments were made the employer had the opportunity
and the responsibility to report any inforrnation which could disqualify the claimant.
SOCIAL BENEFIT PAID FOR
SECURITY YEAREND CLAIM TRANSACTION WEEK AMOUNT
NUMBER EMPLOYEES'NAME DATE LEVEL DATE ENDING ACP CHARGED
THIS IS NOT A BILL OR A REQUEST FOR MONEY DUE TO THIS DEPARTMENT. It is a statement of benefit charges
made to your account during the "reporting" month. At the end of the "posting" month, you will receive a Reimbursable
Bill (Form 1067) for these charges and any previous liability still outstanding.
NEW CHARGES FOR THE REPORTING MONTH 12/09
A MORELLI 09/0.4/10 REG 12/03/09 00 /00 /00 26.54joq 1
1 A MOSIER 11/06/10 REG 12/13/09 12/12/09 89.62
A MOSIER 11/06/10 REG 12/20/09 12/19/09 218.DOr,
A MOSIER 11/06/10 REG 12/27/09 12/26/09 218.00
S M CARY 07/03/10 REG 12/21/09 12/19/09 47.06
S M_ CARY 07/03/10 REG 12/27/09 12/26/09 160.00 c
J N SPENCE 10/23/10 REG 12/07/09 12/05/09 120.78
J N SPENCE 10/23/10 REG 12/14/09 12/12/09 168.00
J N SPENCE 10/23/10 REG 12/20/09 12/19/09 168.00
J N SPENCE 10/23/10 REG 12/27/09 12/26/09 168.00
M A KLAPPER 10/23/10 REG 12 /06/09 12/05/09 81.00
M A KLAPPER 10/23/10 REG 12/13/09 12/12/09 146.00 2
M A KLAPPER 10/23/10 REG 12/20/09 12/19/09 143..00
M A KLAPPER 10/23/10 REG .12/27/09 12/26/09 34.00
C C SECHREST 12/04/10 REG 12/21/09 12/19/09 900.00
C C SECHREST 12/04/10 REG 12/29/09 12/26/09 213.08
M A MONTGOMERY 08714710 REG 12/01/09 11728709 357.00
M A MONTGOMERY 08/14/10 REG 12/09/09 12/05/09 357.00
M A MONTGOMERY 08/14/10 REG 12/14/09 12/12/09 357.00 -1
M A MONTGOMERY 08/14/10 REG 12/21/09 12/19/09 357.00
2 M A MONTGOMERY 08/14/10 REG 12/28/09 12/26/09 12.05
2 J C MOREDOCK 05/29/10 REG 12/27/09 12/26/09 86.99 0
D M LINGELBAUGH 09/18/10 REG 12/06/09 12/05/09 390.00
D M LINGELBAUGH 09/18/10 REG 12/13/09 12/12/09 390.00
D M LINGELBAUGH 09/18/10 REG 12/20/09 12/19/09 390.0011
D M LINGELBAUGH 09/18/10 REG 12/2.7/09 12/26/09 390.00
D EFRIESEN 11/13/10 REG' 12/14/09 11/28/09 346.00 z
J L HOPE 0e/f4710 REG 12/07/09 12/05/09 390.00
I J L HOPE 08/14/10 REG 12/15/09 12/12/09 390.00 l(")
CONTINUE ON NEXT PAGE
An in the ACQ column denotes a charge resulting from an acquisition of another business.
Account/Location Number: 133438 —000 Reporting Month: DECEMBER, 2009 Page 2
Employer Name: CITY OF CARMEL
SOCIAL BENEFIT PAID FOR
SECURITY YEAREND CLAIM TRANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACO CHARGED
NEW ('L RGES FOR THE REPORTING MONTH 12/09
J L HOPE 08/14/10 REG 12/23/09 12/19/09 390.00
J L HOPE 08/14/10 REG 12/29/09 12/26/09 390.00
E, E SWIRSKY _W._.----- 07 24 10 REG 12/ 12/05709 24.68 H
E E SWIRSKY 07/24/10 REG 12/29/09 12/26/09 105.26‘“
L
D E TABELING 11/13/10 REG 12/02709 11/28/09 125.00
D E TABELING 11/13/10 REG 12/07/09 12/05/09 125.00
D E TABELING 11/13/10 REG 12/14/09 12/12/09 125.00 �I�
D E TABELING 11/13/10 REG 12/21/09 12/19/09 125.00
D E TABELING 11/13/10 REG 12/28/09 12/26/09 125.00
J M PENIT 10/16/10 REG 12/07/09 12/05/09 172.00
3 M PENN 10/16/10 REG 12/14/09 12/12/09 172.00 Cl
J M PENN 10/16/10 REG 12/21/09 12/19/09 172.00\ 1
3 M PENN 10/16/10 REG 12/28/09 12/26/09 172.00
J G KOZLOVICH JR 06/05/10 REG 12/18/09 12 12 09 378.00
J G KOZLOVICH JR 06/05/10 REG 12/28/09 12/26/09 314.00\.Q
TOTAL NEW CHARGES FOR THE REPORTING MONTH 12/09 9,428.46
TOTAL AMOUNT OF NET CHARGES 9,428.46
END OF BENEFIT CHARGE STATEMENT
I C IL 1 C Or i i7c 7
1 10 1 -4, k
6L ,s 4 0,3 7) or t 0,,r7
12-o
vs (Q- oo 44 Y,0 L\'
1 a Z0 1:5�0.Uv
4 0 '404 v 0
)2-0 1 1 0 0 0
An in the ACQ column denotes a charge resulting from an acquisition of another business.
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.
146500 Indiana Dept. of Workforce Development Terms
10 North Senate Ave., SE106 Date Due
Indianapolis, IN 46204 -2277
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/8/10 133438 Benefit charge Dec'09 23052 2,801.41
PQY*ALL 101;per Michael 11/20/08.M!
Total 2,801.41
1 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
Ii
Voucher No. Warrant No.
146500 Indiana Dept, of Workforce Development Allowed 20
10 North Senate Ave., SE106
Indianapolis, IN 46204=2277
In Sum of
2,801.41
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or Board Members
INVOICE NO. ACCT AMOUNT
Dept TITLE
23052 133438 4110000 1 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
/2/fr/h1,0
Signature
2,801.41 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
VOUCHER 097212 „WARRANT ALLOWED
'146500 IN SUM OF
IN DEPT OF WORKFORCE DEVEL.
Benefit Administration
10 N. Senate Avenue
Indianapolis, IN 46204
Carmel Wastewater Utility j
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
133438 01- 4080 -12 $692.00
Voucher Total $692.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
c oot
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
146500
IN DEPT OF WORKFORCE DEVEL. Purchase Order No.
Benefit Administration Terms
10 N. Senate Avenue Due Date 12/30/2009
Indianapolis, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
121301200! 133438 $692.00
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
Date Officer
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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, number of units, price per unit, etc.
k Payee Y 1'lJ�[i�;c��� "���tL CV' Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
v:
Total
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.
ALLOWED 20
U rea IN SUM OF
1--
551.06
ON ACCOUNT OF APPROPRIATION FOR
Q3701::P Ly2ACAK)
Board Members
PO# INVOICE NO ACCT #/TITLE AMOUNT hereby certify DEPEP T. I hereb certif that the attached invoice(s), or
I U b 1)( 15(X, 0 p bill(s) is (are) true and correct and that the
■2-01
h[) b b )41.0S materials or services itemized thereon for
f')(-)(2)b i6(00 i) U which charge is made were ordered and
received except
Y f_, 20
p' 1
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
,ALLOWED 20
likliana Department of Workforce Development
Benefit Administration IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204 -2277
$1,560.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO ACCT /TITLE AMOUNT Board Members
1201 j 133438 -000 41 100.00 $1,560.00 I hereby certify that the attached invoice(s), or
I f 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
Thursday, January 28, 2010
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01/08/10 133438 -000 Lingelbaugh Unemployment $1,560.00
hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6
,20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN Department of Workforce Development
Benefit Administration IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204 -2277
$2,411.05
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1207 133438-000 43-470.00 $2,411.05 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
Wednesday, January 20, 2010
Director, Brook YSlre Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 199;
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01/08/10 133438 -000 Unemployment $2,411.0
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.
ALLOWED 20
Indiana_ Department of Workforce Development
IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204
$1,560.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1120 41- 100.00 $1,560.00 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
FEB-! 2010
1` Ix)
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
$1,560.00
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