HomeMy WebLinkAbout192652 12/10/2010 "v. CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURITY AMOUNT: $240.00
CARMEL INDIANA 46)032 DIVISION OF ELEVATOR SAFETY C
4 __�0 302 W WASHINGTON ST, RM E221 CHECK NUMBER: 192652
INDIANAPOLIS IN 46204
CHECK DATE: 12/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4358300 734241112920 240.00 OTHER FEES LICENSES
ELEVATOR OPERATING CERTIFICATE INVOICE
�CARMEL /CLAY BOARD OF PARKS RECREATION 1411 E 116TH ST CARMEL IN 46032
1.If Code An annual test report is due before a permit is issued.
2.If Code A 5 year Test report is due before a r, .znit is issued.
3.Over due fees must be paid before a permit is issued.
If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE
AFFIRMATION" form.
State No Due Over Due Location Address
111704 $120.00 0.00 1235 CENTAL PARK DR EAST, CARMEL IN 46032
111978 $120.00 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 46032
Purchase �p cn n p vt" �G��
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P.O. or F
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Budget
Line Descr U �l �'1,���
Purchaser Date a'
Approval s l.` Date i
Reference Number Invoice Date Please submit ENTIRE document with payment
134241- 11292010 -1 11/29/2010 Unit(s) 2 Total Due upon receipt
of 2 240.00 of 240.00
Ref.Num.:734241- 11292010 1 $240 of 240.Qrl Invoice Date 11/29/2010
If Paying by check, include a check made payable to the Department of Homeland
security. If Paying by American Express /Discover /Master Card, complete the following
information and return by mail :Indiana Department of Homeland Security, Fiscal
Department, 302 W.Washington St., Rm E221,Indiariapolis, IN 46204 or fax to (317)233-
0401. Questions? call(317)232 -6427 or E- mail :elevator- invoice@dhs.in.gov
2.25% convenience fee charged on all credit card payments.
Full Name on Credit Card
Billing Address: Street
City State Zip Code
Credit Card: American Express /Discover /Master Card ONLY (circle one)
Acct. Number Exp.Date (mm/yy)
CVV2 Number Contact Phone Number Signature
By signing, cardmember agrees to the obligations s forth by the Cardmember's
Agreement with the issuer.
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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.
229400 Indiana Department of Homeland Security Terms
Fiscal Department
302 W Washington St., Rm E221
Indianapolis, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
11/29/10 73424111292010 Elevator permits 240.00
Total 240.00
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.
229400 Indiana Department of Homeland Security Allowed 20
Fiscal Department
302 W Washington St., Rm E221
Indianapolis, IN 46204 In Sum of
240.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1091 73424111292010 4358300 240.00 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
9 -Dec 2010
Signature
240.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund