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Home My WebLink About187624 07/20/2010 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $7,145.48 CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV o� 101 N SENATE AVE CHECK NUMBER: 187624 INDIANAPOLIS IN 46206 -0847 CHECK DATE: 7/2012010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 101 5023990 695.40 OTHER EXPENSES 1125 4110000 1,380.08 FULL TIME REGULAR 1160 4110000 1,950.00 FULL TIME REGULAR 1192 4110000 1,560.00 FULL TIME REGULAR 601 5023990 1,560.00 OTHER EXPENSES e` 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 CIVIC SQ REPORTING MONTH JUN, 2010 CARMEL IN 46032 -2584 NETCHARGES $7,145.48 POSTING DATE JUL 02, 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 FOR SECURITY YEAR END I CLAIM TRANSACTION WEEK AMOUNT NUMBER I EMPLOYEE'S NAME DATE LEVEL DATE I ENDING 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 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 06/10 C MURRAY 06/04/11 REG 06/21/10 06/19/10 132.00 CONTINUE ON NEXT PAGE An in the ACQ column denotes a charge resulting from an a quisitio 1��7��- r�o �,�-`1v�2 40 72 of another business. S� ZZ Z sz� 4� E� �DUC� i v Account/Location Number: 133438 --000 Reporting Month: JUNE, 2010 Page 2 Employer Name: CITY OF CAMEL SOCIAL B FIT I PAID FOR SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT NUMBER I EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACO CHARGED NEW CHARGES FOR THE REPORTING MONTH 06/10 C MURRAY 06/04/11 REG 06/29/10 06/26/10 132.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 06/10 7,145.48 TOTAL AMOUNT OF NET CHARGES 7,145.48 END OF BENEFIT CHARGE STATEMENT An in the ACID column denotes a charge resulting from an acquisition of another business. VOUCHER NO. WARRANT NO. ALLOWED 20 Indiana Department of Workforce Development IN SUM OF Benefit Administration, 10 N. Senate Ave Indianapolis, IN 46204 -2277 $1,950.00 ON ACCOUNT OF APPROPRIATION FOR Mayor's Office PO# I Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members 1160 Statement 41- 100.00 $1,950.00 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 Thursday, July 15, 2010 ayor 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)) 07/02/10 Statement $1,950.00 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 102235 WARRANT ALLOWED 146500 IN SUM OF IN DEPT OF WORKFORCE DEVEL. 10 N. Senate Avenue, Ste 106 Indianapolis, IN 46204 Carmel Water utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 0610 01- 4080 -12 $1,560.00 Voucher Total $1,560.00 Cost distribution ledger classification if claim paid under 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 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. 10 N. Senate Avenue, Ste 106 Terms Indianapolis, IN 46204 Due Date 7/16/2010 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 7/16/2010 0610 $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 Date Officer 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 7/2/10 133438 Benefit char a Jun'10 1,380.08 FAY &ALL OUT OF 101_ per�Mlchael 1: 120/08 Total 1,380.08 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., SE106 Indianapolis, IN 46204 -2277 In Sum of 1,380.08 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 1125 133438 4110000 1,380.08 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 15 -Jul 2010 4W LaqZBtn Q Signature 1,380.08 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund L 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 DOCS Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1192 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 Friday, July 16, 2010 Directo OCS 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)) 07/15/10 Unemployment Laura Rouse Devore $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 Cleric- Treasurer