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HomeMy WebLinkAbout189009 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 361011 Page 1 of 1 ONE CIVIC SQUARE STATEWIDE MEDICAL SERVICES CARMEL, INDIANA 46032 3601 E 9TH ST CHECK AMOUNT: $73.84 INDPLS IN 46201 -2511 CHECK NUMBER: 189009 CHECK DATE: 8118/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1094 4350900 210673 36.92 OTHER CONT SERVICES 1094 4350900 210860 36.92 OTHER CONT SERVICES 1 111111 VIII VIII VIII VIII VIII IIII IIII STATEWIDE MEDICAL SERVICES INVOICE Full Service Medical Waste Disposal 3601 East Ninth Street Indianapolis, Indiana 46201-2511 Invoice Date Invoice (317) 634 -0801 07/22/2010 210673 Invoice Due: 8/21/2010 service Address: CARMEL CLAY PARKS RECREATION CARMEL CLAY PARKS RECREATI ATTN: ACCOUNTS PAYABLE MONON CENTER 1411 E. 116TH ST. 1235 CENTRAL PARK EAST CARMEL IN 46032 CARMEL IN 46032 -3455 Account Number: 3210 P.O. Number: Terms. Net 30 Date Description Manifest Department: Qty Lbs Rate Amount 0711612010 Regulated Medical Waste 2.25 Cu. Ft. 273314 1 Containers $32.50 $32.50 Box 07116/2010 Energy Surcharge 273314 1 $4.42 $4.42 Total $36.92 Sales Tax $0.00 Total Invoice Due $36.92 7 19 51 JUL 2 2010 DESTRUCTION CERTIFIED Waste destroyed in accordance with all applicable BY: federal, state, and local regulations. Purchase J n Description _V"rr�G�LtP�Y Il�r P.O.# PorF G.L. q Budget Line t?escr D{W,VX CpY S1/CS Purchaser Date Approval Date BIOHAZARDOUS WASTE MANIFEST Hazardous Materials Bill of Lading 273314 SPILL EMERGENCIES ONLY: 800 -535 -5053 Ma1Wst Number GenereM.WEInf� RECREAMN T of Waste: Name Y 1 Statewide Medical Services Darob, Inc. 123-1 CENTRAL PARK 3601 East 9th Street 1801 Research Drive Address Indianapolis, IN 46201 Louisville, KY 40269 (317) 634 -0801 (502) 491 -1535 Cit 1 U.S.D.O.T. 725204 Zip Contact Account Number County Telephone weekly UN3291, REGULATED MEDICAL WASTE, n.o.s., 6.2, PG II Customer P/U Hours: Container Size— Quantity Re ived Weight Monday: Tuesday: Wednesday: Thursday: Friday: Generator (Shipper) Certification: Transporter (Consignee) Certification: This is to certify that the here -in -named materials are properly This is to certify that the here -in -named materials are properly classified, described, packaged, marked, labeled, and are in classified, described, packaged, marked, labeled, and are in proper condition for transportation according to applicable proper condition for transportation according to applicable regulations of the U.S. Department of Transportation. regulations of the U.S. Department of Transportation. Materials will be destroyed in accordance with all applicable local, state By Date and federal regulations. Signa tu of authorized representative t waste generator. rint BY Date 7- Traa s por tt er t Route Last P/U Print Nam E!Week'Fri Nod Pickup: 7123/2010 Notes: By Date Transporter 2 Print Name Type ;3fDestruetio By Date Transporter 3 Print Name Liners OH: Designated Facilities: Containers OH: Statewide Medical Services *1)801 arob, Inc. 3601 E=ast 9th Street Research Drive Indianapolis, IN 46201 Louisville, KY 40269 Arriv epart Service Time: (317) 634 -0801 (502) 491 -1535 PAM PFAYMNGER U.S.D.O.T. 725204 Certificate of Destruction: Certifi ion of cei and destruc n of RMW materials covered by this ma Pest num err Signature Date L° Original: Statewide Medical Service Copy: n or of Waste Certificate of Destruction to Accompany Invoice STATEWIDE MEDICAL SERVICES INVOICE Full Service Medical Waste Disposal 3601 East Ninth Street Indianapolis, Indiana 46201-2511 Invoice Date Invoice (317) 634 -0801 07/26/2010 210860 Invoice Due: 8/25/2010 JUL 3 0 2010 pp Service Address: A CARMEL CLAY PARKS RECREATI CARMEL CLAY PARKS RECREA°fION ATTN: ACCOUNTS PAYABLE MONON CENTER 1411 E. 116TH ST, 1235 CENTRAL PARK EAST CARMEL IN 46032 CARMEL IN 46032 -3455 Account Number: 3210 P.O. Number: Terms:._ _Net_30r Date Description Manifest Department: Qty Lbs Rate Amount 07/23/2010 Regulated Medical Waste 2.25 Cu. Ft. 4273814 1 Containers $32.50 $32.50 Box 07/23/2010 Energy Surcharge 273814 1 $4.42 $4.42 Total $36.92 Sales Tax $0.00 Total Invoice Due $36.92 DESTRUCTION CERTIFIED Waste destroyed in accordance with all applicable federal, state, and local regulations. Purchase R� a- w Description P.O.# PorF e.L. I 3 5o U L t Desrar '1�1' CUh�"Y, c:� Purchaser Date j App r► Dated BIOHAZARDOUS WASTE MANIFEST Hazardous Materials Bill of Lading 273814 SPILL EMERGENCIES ONLY: 800 535 -5053 Manifest Number Generator (Shipper) of Waste: ;Transp ter of Waste: Name CARME CLAY PARKS RECREATION MONON CENTER Statewide Medical Services Darob, Inc. 1� CENTRAL. PAR AST 3601 East 9th Street 1801 Research Drive 'Address Indianapolis, IN 46201 Louisville, KY 40269 (317) 634 -0801 (502) 491 -1535 City State IN U.S.D.O.T. 725204 Zip 46032 -3455 Contact C AR ME KEAVENEY Account Number 3210 County Telephone (317) 573 -5250 Weekly UN3291, REGULATED MEDICAL WASTE, n.o.s., 6.2, PG II Customer P/U Hours: _—.Container. Size Quantity Rec ved Weight Monday: 2 ,2 5 Cu. Ft. Box 1 Tuesday: Wednesday: Thursday: Friday: Generator (Shipper) Certification: Transporter (Consignee) Certification: This is to certify that the here -in -named materials are properly This is to certify that the here -in -named materials are properly classified, described, packaged, marked, labeled, and are in classified, described, packaged, marked, labeled, and are in roper condition for transportation according to applicable proper condition for transportation according to applicable egulations of the U.S. Department of Transportation. regulations of the U.S. Department of Transportation. Materials will be destroyed in accordance with all applicable local, state By Date and federal regulations. Signature of authorized representative of waste generator. Print Name lr BY Date ra orte 1 Rout Y -NW-A: Last P/U 07/16/2010 Print Name �T s N ot el -Week Fri Nam Pidw: 7/30/2010 B Date Transporter 2 Print Name T ype Of Destructlo By Transporter 3 Date Print Name Liners OH: Designated Facilities: Containers OH: Statewide Medical Services Darob, Inc. 3601 East 9th Street 1801 Research Drive Arrive Depart Service Time: Indianapolis, IN 46201 Louisville, KY 40269 (317) 634 -0801 (502) 491 -1535 PAM PFAFFINGFR U.S. D.O.T. 725204 Certificate of Destruction: Cer, i is on of receipt an r on o R W materials covered by this manifest rjUm er: 0 Signature Date Lo Original: Statewide Medical vices Copy: Generator of Waste Certificate of Destruction to Accompany Invoice 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. 361011 Statewide Medical Services 3601 E. 9th St. Date Due Indianapolis, IN 46201 -2511 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 7/22/10 210673 Re ulated Medical Waste 36.92 7126110 210860 Regulated Medical Waste 36.92 Total 1 73.84 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 361011 Statewide Medical Services 3601 E. 9th St. Indianapolis, IN 46201 -2511 In Sum of 73.84 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #1TITLE AMOUNT Board Members Dept 1094 210673 4350900 36.92 1 hereby certify that the attached invoice(s), or 1094 210860 4350900 36.92 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 12 -Aug 2010 '�im� Signature 73.84 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund I