HomeMy WebLinkAbout183336 03/16/2010 CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURI
I CARMEL, INDIANA 46032 DIVISION OF ELEVATOR SAFETY HECK AMOUNT: $360.00
302 W WASHINGTON ST, RM E221 CHECK NUMBER: 183336
OM INDIANAPOLIS IN 46204
CHECK DATE: 3/16/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 7675 0301201 120.00 BUILDING REPAIRS MA
1205 4351501 7675 0301201 240.00 EQUIPMENT MAINT CONTR
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ELEVATOR OPERATING CERTIFICATE INVOICE
CARMEL PUBLIC WORKS SAFETY ONE CIVIC SQ CARMEL IN 46032
1.If Code An annual test report is due before a permit is issued. i
2.If Code A 5 year Test report is due before a permit is issued.
3.Over 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 Due Over Due Location Address
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45581 $120.00 0.00 3 CIVIC SQ, CARMEL IN 46032
45582 $120.00 0.00 1 CIVIC SQ, CARMEL IN 46032
45583 $120.00 0.00 1 CIVIC SQ, CARMEL IN 46032
MAR 15 2010
C;-.,) Z, o"
1)) 3 By
Reference Number Invoice Date Please submit ENTIRE document with payment
7675 03012010 -1 03/01/2010 Unit(s)! 3 Total Due upon receipt
of 3 360.00 of 360.00
Ref.Num.:7675- 03012010 -1 $360 of 360.00 Invoice Date 03/01/2010
If Paying by check, include a check made payable to the Department of Homeland
security. If Paying by Visa or Master Card, complete the following information and
return by mail :Indiana Department of Homeland Security, Fiscal Department, 302
W.Washington St., Rm E221,Indianapolis, IN 46204
or fax to (317)233 -0401. Questions? call(317)232 -6427 or
E- mail :elevator- invoice@dhs.in.gov:
Full Name on Credit Card
I
Billing Address: Street
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City State Zip Code
Credit Card: Visa MasterCard 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
Agreement with the issuer.
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VOUCHER NO. WARRANT NO
I�4 Department of Homeland Security ALLOWED 20
Fiscal Department IN SUM OF
302 W. Washington St., Rm E221
Indianapolis, IN 46204
i
$360.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
I
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
I 11 f 7675 03012010 1 —EZ)1 I $120.00 1 hereby certify that the attached invoice(s), or
1205 7675 03012010 I 43 515.01 I $240.00 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
Friday, March 12, 2010
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
i
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.
Term s
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
03/01 /10 7675- 03012010 $120.00
03/01/10 I 7675 03012010 I I $240.00
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