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Home My WebLink About184650 04/26/2010 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV CHECK AMOUNT: $8,161.03 r' 101 N SENATE AVE CHECK NUMBER: 184650 INDIANAPOLIS IN 46206 -0847 CHECK DATE: 4/26/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4110000 04022010 1,127.44 FULL TIME REGULAR 1160 4110000 04022010 1,950.00 FULL TIME REGULAR 1192 4110000 04022010 3,120.00 FULL TIME REGULAR 1201 4110000 04022010 1,560.00 FULL TIME REGULAR 1207 4110000 04022010 403.59 FULL TIME REGULAR 133438 -1 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, 1NDIANAPOUS, IN 46204 -2277 Toll tree 1- 800.691 -6499 Marion County 232.7436 STATEMENT OF BENEFIT CHARGES (FORM 535) CONFIDENTIAL RECORD PURSUANT TO IC 22- 4 -19 -6, IC 4 -1 -Bb Page 1 CITY OF CARMEL Q a ACCOUNT/ ATTN CLERK TREASURER LOCATION NUMBER 133438 -000 ONE CIVIC SQ APP 2 6 2010 REPORTING MONTH MAR, 2010 CARMEL IN 46032 -2584 NET CHARGES $8,161.03 By POSTING DATE APR- 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 information which could disqualify the claimant. SOCIAL BENEFIT PAID FO SECURITY YEAR END I CLAIM TRANSACTION I WEEK AMOUNT NUMBER EJ4M1PLOYEE'S NAME DATE LEVEL DATE ENDING I ACO 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 and 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 03/10 D D MORRIS 01/08/11 REG 03/03/10 02/27/10 l) 390.00 D D NORRIS 01/08/11 REG 03/09/10 03/06/10 390.00 D D NORRIS 01/08/11 REG 03/15/10 03/13/10 390.00 D D NORRIS 01/08/11 REG 03/25/10 03/20/10 390.00 Q D D NORRIS 01/08/11 REG 03/28/10 03/27/10 390.00 E N BROWN 12/113/10 RE 12/27/1 2 28,00 D M LINGELBAUGH 09/18/10 REG 03/07/10 03/06/10 390.00 D M LINGELBAUGH 09/18/10 REG 03/14/10 03/13/10 Q D M LINGELBAUGH 09/16/10 REG 03/21/10 03/20/10 390.00 D M LINGELBAUGH 09/16/10 REG 0 3/28/10 03/27/10 390.00 K NEFOUSE 02/05/11 REG 03/07/10 03/06/10 q 71.09 K NEFOUSE 02/05/11 REG 03/16/10 03/13/10 2B .B6 L B OUSE- DEVORE 12/25110 REG 03/02/ 02 10 90.00 L B ROUSE DEVORE 12/25/10 REG 03/11/10 03/06/10 0� 390.00 L B ROUSE DEVORE 12/25/10 REG 03/18/10 03/13/10 {J�• 390.00 _L B ROUSE— DEV ORE 12/25/10 REG 03/22/10 03/20/10 1 390.00 V D E FRIESEN 1 13 10 R 03 O1 10 0 13 10 3 E E SWIRSKY 0 3/ 7/24110 RE _00_2_/10 1_1 07_/_09 D E TABELING 11/13/10 REG 03/01/10 02/27/10 78.00 Q J N PENN 10/ REG 03/03/10 02/27710 172.00 J M PENN 10/16/10 REG 03/10/10 03/06/10 172.00 J N PENN 10/16/10 REG 03/16/10 03/13/10 G,L 172.00 J M PENN 10/16/10 REG 03/24/10 03/20/10 172.00 I J M PENN 10/1 REG 03/29/10 0 3/27/10 172.00 I B W POHL 12/18/10 REG 03/07/10 03/06/10 390.00 I B W POHL 12/18/10 REG 03/14/10 03/13/10 0 390.00 B W POHL 12/18/10 REG 03/21/10 03/20/10 O 390.00 B W POHL 12/18/10 REG 03/28/10 03/27/10 390.00 CONTINUE ON NEXT PAGE An in the ACO column denotes a charge resulting from an acquisition of another business. Account/Location Number: 133438 —ODO Reporting Month: MARCH, 2010 Page 2 Employer Name: CITY OF CARREL BENEFIT PAID O SECURITY YEAR l=ND CLAIM ANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACQ CHARGED NEW CHARGES FOR THE REPORTING MONTH 03/10 TOTAL NEW CHARGES FOR THE REPORTING MONTH 03/10 8,226.02 REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 10/09 303 -02 -6167 D M JENSEN 08/28/10 REG 03/22/10 09/19/09 64.99CR I" TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 10/09 64.99C TOTAL AMOUNT 'OF NET CHARGES B,161.03 The following charge(s) are POTENTIAL credits to your account. A determination was made and you were found not liable for these charges. But because you have chosen to make payment in lieu of contributions for Unemployment Insurance, your account cannot be credited for these charges unless or until the claimant(s) refund the overpayment Your account will be credited as the claimant refunds the overpayment in full or in monthly installments_ D M JENSEN 08/26/10 REG 09/19/09 325.01 F D M JENSEN 08/28/10 REG 09/26/09 390.00 D M JENSEN 08/28/10 REG 10/03/09 390.00 D M JENSEN 08/28/10 REG 10 /10/09 390.00 D M JENSEN 08/28/10 REG 10/17/09 390.00 D M JENSEN 08/28/10 REG 10/24/09 390.00 D M JENSEN OB/28/10 REG 10/31/09 250.00 E E S WIRSKY E E SWIRSKY 07/24/10 REG 12/05/09 24.08 i E E SWIRSKY 07/24/10 REG 12/26/09 105.26 3 t E E SWIRSKY 07/24/10 REG 02/06/10 3.28 END OF BENEFIT CHARGE STATEMENT 00 DO c o 0, C)o t j An in the ACQ column denotes 2 charge resulting from an acquisition of another business.. VOUCHER NO. WARRANT NO. ALLOWED 20 Indiana 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 I 133438 -000 I 41- 100.00 $1,560.00 1 hereby certify that the attached invoice(s), or I 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, April 23, 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. 19Q5) 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 Da Numbe no attac invoice(s) or bill(s)) 04/02/10 133438 -000 March 2010 Reporting Month $1,560.00 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Ind.,�ana Department of Workforce Development Benefit Administration IN SUM OF 10 North Senate Avenue Indianapolis, IN 46204 -2277 $3,120.00 ON ACCOUNT OF APPROPRIATION FOR Carmel DCCS Department PO# Dept. INVOICE NO. CT /TITLE AMOUNT Board Members 1192 41- 100.00 $3,120.00 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 Friday, April 23, 2010 irector, CS 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)) 04/02/10 Unemployment, Pohl, Rouse Devore $3,120.00 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. ALLOWE D 20 IN Department of Workforce Development Benefit Administration IN SUM OF 10 North Senate Avenue Indianapolis, IN 46204 -2277 $403.59 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1207 133438MAR10 41- 110.00 $403.59 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 Monday, April 19, 2010 Director, Br kshire 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. 1 M 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)) 04/02/10 133438MAR10 Unemployment $403.E 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 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., SE 106 Date Due Indianapolis, IN 46204 -2277 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 4!2110 133438 Benefit charge Mar'10 1,127.44 PAY ALI:COUT OFp 1,01 er Michae111120 /,08 Total 1,127.44 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 Voucher No. Warrant No. 146500 Indiana Dept. of Workforce Development Allowed 20 10 North Senate Ave., SE 106 Indianapolis, IN 46204 -2277 In Sum of 1,127.44 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 1125 133438 4110000 1,127.44 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 22 -Apr 2010 Signature 1,127.44 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund