HomeMy WebLinkAbout184650 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