The URL can be used to link to this page

Home My WebLink About190005 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 361011 Page 1 of 1 s4•�; \yf ONE CIVIC SQUARE STATEWIDE MEDICAL SERVICES I' CHECK AMOUNT: $110.76 a CARMEL, INDIANA 46032 3601E 9TH ST INDPLS IN 46201 -2511 CHECK NUMBER: 190005 CHECK DATE: 9/14/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1094 4350900 211813 36.92 OTHER CONT SERVICES 1094 4350900 212043 36.92 OTHER CONT SERVICES 1094 4350900 212252 36.92 OTHER CONT SERVICES n :s 0 I IIIIII VIII VI II VIII VIII VIII /III /III STATEWIDE MEDICAL SERVICES I Full Service Medical Waste Disposal 3601 East Ninth Street Indianapolis, Indiana 46201-2511 Invoice Date Invoice (3 17) 634 -0801 08/17/2010 211813 Invoice Due: 9/16/2010 l�lo�I�II�,II„�s�llea�I�ll 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: 1 3210 -P.O._ Number: I Terms I Net 30 Date Description Manifest Department: Qty Lbs Rate Amount 08/0612010 Regulated Medical Waste 2.25 Cu. Ft. 274874 1 Containers $32.50 $32.50 Box 08/06/2010 Energy Surcharge #274874 1 $4.42 $4.42 Total $36.92 Sales Tax $0.00 w ig Total Invoice Due $36.92 AUG 1 9 2010 BY DESTRUCTION CERTIFIED Waste destroyed in accordance with all applicable federal, state, and local regulations. Purchase p� Description P or F P.O. G. L. 3 5Q g._ Budget Line Descr n Date_____ Purchaser Approval Date 1310HAZARDOUS WASTE MANIFEST Hazardous Materials Bill of Lading 274874 SPILL EMERGENCIES ONLY: 800- 535 -5053 Manifest Number Generator (Shipper) of Waste: Transporter of Waste: Name CAR.MEL- CLAY PARKS RECREATION MONON CENTER Statewide Medical Services Darob, Inc. 1235 C� PARK EAST 3601 East 9th Street 1801 Research Drive Address Indianapolis, IN 46201 Louisville, KY 40269 (317) 634 -0801 (502) 491 -1535 CitR State IN U.S.D.O.T. 725204 zip 46032 -3455 Contact CARRIEREAVENEY Account Number 3210 County Telephone (317) 573 -5250 Weekly UN3291, REGULATED MEDICAL WASTE, n.o.s., 6.2, PG it Customer P/U Hours: Container Size Quantity R lved Weight Monday: 2 .25 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 proper condition for transportation according to applicable proper condition for transportation according to applicable r ulations of the U.S. Department of Transport regulations of the U.S. Department of Transportation. Materials will be destroyed in accordance with all applicable local, state Date and federal regulations. Signa re of authorized represen iv f waste generator. B y Dat int Name Trans rter Rout NW-A Last P/U 07/30/2010 Print Name f Not esE.lWeek Fri NotPidw: 8/13/2010 By Date Transporter 2 Print Name Type Of DeAmetio By Transporter 3 Date Print Name Liners OH: Designated Facilities: Containers OH: Statewide Medical Services rob, Inc. 3601 East 9th Street 1801 Research Drive Arrive Depart: ervice Time: Indianapolis, IN 46201 Louisville, KY 40269 V (317) 634 -0801 (502) 491 -1535 PAM PIFAFFIIZGER U.S.D.O.T. 725204 Certificate of Destruction: Certi c tion rec t and st ction of RMW materials covered by this nifest n m Signature Date b Original: Statewide Medical Servi C n razor of Waste Certificate of Destruction to Accompany Invoice I lllfll 11111 11111 11111 11111 1111/ 1111 1111 STATEWIDE MEDICAL SERVICES INVOICE Full Service Medical Waste Disposal 3601 East Ninth Street Indianapolis, Indiana 46201-2511 Invoice Date Invoice (317) 634 0801 08/19/2010 212043 Invoice Due: 9/18/2010 AUG 2 5 1010 I I II„II II eIoII By..�� 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 Ac count Number: 321 P.O. Numb er: Terms; _Ne Date Description Manifest Department: Qty Lbs Rate Amount 08/1312010 Regulated Medical Waste 2.25 Cu. Ft. 275377 1 Containers $32.50 $32.50 Box 08/13/2010 Energy Surcharge 275377 1 $4.42 $4.42 Tota 1 $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 n Description �U C� MALCk K) a& P.Q. P or F G.L. 10 Il q q15 Bud t cp-/ Pz CO QY. SyG5 Line esc Purchaser Data Approval Date Illlllllllllllfllllfllllllllllllllllllll STATEWIDE MEDICAL SERVICES INVOICE Full Service Medical Waste Disposal 3601 East Ninth Street 19 Indianapolis, Indiana 46201-2511 y Invoice Date IrlvolCe (3 17) 634 -0801 AUG 3 0 2010 08/25/2010 212252 Invoice Due: 9/24/2010 BY....................... 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: I Terms:_ Net 30 Date Description Manifest Department: Qty I Lbs Rate Amount 08/20/2010 Regulated Medical Waste 2.25 Cu. Ft. 275994 1 Containers $32.50 $32.50 Box 08/20/2010 Energy Surcharge 275994 1 $4.42 $4.42 Tota 1 $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 Descriptio LATE[) MF-0! CAL WgSTE P.O.# PorF a.L. st OG y 35dg0o Line D�cr Purchaser Date �°�i'prov Date BIOHAZARDOUS WASTE MANIFEST Hazardous Materials Bill of Lading 2 ?994 SPILL EMERGENCIES ONLY: 800- 535 -5053 Manifest Number Generator (Shipper) of Waste: Trans ter of Waste: CARMEL. CLAY PARKS RECREATION Name Statewide Medical Services Darob, Inc. Address 123 5 CENTRAL PARK EAST 3601 East 9th Street 1801 Research Drive Indianapolis, IN 46201 Louisville, KY 40269 (317) 634 -0801 (502) 491 -1535 CARAdn Cit State IN U.S.D.O.T. 725204 Y zip 4603 3455 Contact CAR IE 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 Monda Y 2.25 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 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. Signature of au rep rltati e of waste generator. Print Name c Date Trans orter Rout V A Last P/U U/13 .010 Print Name NoteFlWeek Fri Neud Pickup: 8/27/2010 By Date Transporter 2 Print Name T ype Of Destmalo By Transporter 3 Date Print Name Liners OH: Designated Facilities: Containers OH: El Statewide Medical Services A/� Darob, Inc. 3601 East 9th Street 1801 Research Drive �i Arrive: Depart Service Time: Indianapolis, IN 46201 Louisville, KY 40269 317 634 -0801 (502) 491 -1535 U.S.D.O.T. 725204 P FAFMGER Certificate of Destruction: Certifi ,a on f rec ei�pt�nd destruction of �iMW materials covered by this ma st numb r: Signature 'aka Date Original: Statewide Medical Servlc 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 8117110 211813 Regulated Medical Waste 36.92 36.92 8119110 212043 Re ulated Medical Waste 36.92 8/25/10 212252 Re ulated Medical Waste Total 110.76 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 110.76 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1094 211813 4350900 36.92 1 hereby certify that the attached invoice(s), or 1094 212043 4350900 36.92 bill(s) is (are) true and correct and that the 1094 212252 4350 36.92 materials or services itemized thereon for which charge is made were ordered and received except 9 -Sep 2010 Signature 110.76 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund