193022 12/22/2010 (9D CITY OF CARMEL, INDIANA VENDOR: 00352914 Page 1 of 1
ONE CIVIC SQUARE AMERICAN INDUSTRIAL SERVICES
CARMEL, INDIANA 46032 8500 GEORGETOWN ROAD CHECK AMOUNT: $711.16
INDIANAPOLIS IN 46268 CHECK NUMBER: 193022
CHECK DATE: 12122/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4239099 3W1011A 711.16 OTHER MISCELLANOUS
INVOICE
n�y 8500 Georgetown Road
e 1 1� Indianapolis, 6 I N 46269
71-4090
Fy Phone: (317)
Fax: (3171871 -4094
TOLL FREE 1.800. 877 -4955
IiN'VOICE NO: 31` IA
INVOICE DATE: 11/30/2009
CLIENT:
PROJECT INFORMATION
Mr. Jeff Barnes PROJECT ID:
Facilities Manager DESCRIPTION: E -SCRAP RECYCLING
City of Carmel LOCATION: CARMEL
One Civic Square
Carmel, IN 46032
CONTRACT NO:
CONTACT: JEFF BARNES PROJECT MGR: GREG SPEARS.
WORK PERFORMED THRU:
WASTE MANAGEMENT SERVICES
DESCRIPTION UNIT QUANTITY PRICE /UNIT TOTAL
E- SCRAP RECYCLING 2778.00 0.22 611.16
TRANSPORTATION 1.00 100.00 100.00
L.l
D
DEC 2 0 C010
By
TOTAL
INVOICE 711.16
TERMS: NET 30 DAYS
LATE PAYMENTS WILL BE CHARGED INTEREST AT 1.5% PER MONTH
REMIT PAYMENT TO: AMERICAN INDUSTRIAL SERVICES, 8500 GEORGETOWN RD, INDIANAPOLIS, IN 46268 -1647
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j �qf,f Electronic equipment has been properly recycled or refurbished in accordance with all federal, state
and local regulations or other applicable regulations regarding the processing of scrap electronic
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equipment. All data will be removed from electronc storage devices either electronically or
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physically to ensure data cannot be retrieved under any means. Whatever equipment can not be
reused will be disassembled for recycling.;
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CITY OF CARMEL
Name of Customer
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NON HAZARDOUS^ 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4, Waste Tracking Number
1 MANIFEST CESQG 1 317 339 -1430 10290'
5- Generator's Name and Mailing Address Generator's Site Address (if different than mailing address)
CITY OF CARMEL
0 CIVIC SQUARE
Gen�r sAWIN. 46032 317 -571 -2400
n. Transporter 1 Company Name
U.S. EPA ID Number
k
AMERICAN INDUSTRIAL SERVICES INR000017350
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7. Transporter 2 Company Name U.S. EPA ID Number
S. Designated Facility Name and Site Address U.S. EPA 10 Number
MP C
2300 PILOT KNOB ROAD
Fa �Q�TA EIGHTS, MN. 55120
Fps
w 9. Waste Shipping Name and Description 10. Containers 11, Total 12. Unit
�ac No. Type Quantity Wt.Nol.
1.
r a NON— HAZARDOUS —NON— REGULATED ELECTRONIC WASTE
a FOR RECYCLING (BOX) 7
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2. r� :v t1 z�s" Ja_ r..3 C,
4,
40
13. Special Handling Instructions and Additional Information
14. GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. Y
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Gene rator'sOfferors Printedr1 ed Name Si nat r tx'
YP g Month Day Year
15. International Shipments
z Import to U.S. Export from U S. Pori of entrylexit:
Transporter SI nature for o
ex rts onl le
expo Da le 9eaeina U.S.:
16. Transporter Acknowledgment of Receipt of Materials
r LU Trans orter i P' fr
y p lioted u ed �Lrne Signature Month Day Year
E7 V..'
Y Transporter 2 Printed(Typed Name Signature Month Day Year "n
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N
f 17. Discrepancy
17a. Discrepancy Indication Space
r' Quantity Type Residue Partial Rejection Full Rejection r
a
F� Manifest Reference Number
17b. Alternate Facility (or Generator) U.S. EPA ID Number
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L Facility's Phone:'
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17c. Signature of Alternate Facility (or Generator) Month Day Year r
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Ssq 18. Designated Facility Owner or Operator: Certification of receipt of materials covered by the manifest except as noted in Item 17a
t1 Printed/Typed Name Signature Month Day Year
169- 8I_C -0 6 10498 (Rev. 8ro6) I DESIGNATED FACILITY To GENERATOR
VOUCHER NO. WARRANT NO.
ALLOWED 20
American Industrial Services
IN SUM OF
8500 Georgetown Road
Indianapolis, IN 46268
$711.16
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1205 I 3W1011A I 42-390.991 $711.16 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, December 20, 2010
Director, Administration
Title
tion ledger classification if
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))
11130/09 3W1011A $711.16
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