Loading...
HomeMy WebLinkAbout194362 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 361011 Page 1 of 1 ONE CIVIC SQUARE STATEWIDE MEDICAL SERVICES 0 CHECK AMOUNT: $36.92 .�.J' CARMEL, INDIANA 46032 3601E 9TH ST INDPLS IN 46201 -2511 CHECK NUMBER: 194362 CHECK DATE: 2/3/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1094 4350900 218846 36.92 OTHER CONT SERVICES I111111IIIIIVIIIVIIIIIIIVIIIIIIIIIII STATEWIDE MEDICAL SERVICES INVOICE Full Service Medical Waste Disposal 3601 East Ninth Street Indianapolis, Indiana 46201-2511 Date Invoice (3 17) 634 -0801 12/31/2010 218846 r� Invoice Due: 1/30/2011 BYm I�I,�I�Ildoll,��„II�„I�II 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: _321,0 1 P.O_ Number: I Terms: Net 30. 1 Date Description Manifest Department: Qty Lbs Rate Amount 12/31/2010 Regulated Medical Waste 2.25 Cu. Ft. 285814 1 Containers $32.50 $32.50 Box 12/31/2010 Energy Surcharge 285814 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 aescdptlori �/Qaze P.0. Pore a.L# /d 94'- �,3SD9QD Budget Line Dew P�JIC�1a8ar DB��.rr,. SIOHAZARDOUS WASTE MANIFEST 285814 Hazardous Materials Bill of Lading SPILL EMERGENCIES ONLY: 800- 535 -5053 Manilst Number Gener RECREATI N Transporter of Waste: Name MGNO CT-NT E 123 5 eENTRAL PARK EL;. �U TA 5 Medical Services Darob, Inc. 3601 East 9th Street 1801 Research Drive Address Indianapolis, IN 46201 Louisville, KY 40269 0—"A *M (317) 634 -0801 (502) 491 -1535 City �e_s c CIA- nnrr ter. a t#aiersr U.S. D.O.T. 725204 46032 =34 s v ffmy Zip Conta Account Number County Telephone Weekly UN3291, REGULATED MEDICAL WASTE, n.o.s., 6.2, PG It Customer P/U Hours: Container Size Quantity R eived Weight Monday: 2.25 Cu. Ft. Box 1 Tuesday: Wednesday: Thursday: Friday: Generator (Shipper) Certification: Transporter (Consignee) Certification: This is to certify that t here -in -named materials are properly This is to certify that the here -in -named materials are properly classified, des i cl -'p ckaged, marked, labeled, and are in classified, described, packaged, marked, labeled, and are in roper con f d' io ansportation according to applicable proper condition for transportation according to applicable regulations f t U S De artment of Transportatio regulations of the U.S. Department of Transportation. Materials will be destroyed in accordance with all applicable local, state By Date! J(! and federal regulations. Sign tire of uth razed r ntative of waste generator. int Name E Transport IND -A 1210312010 Route Last P/U Print Name ElMonth Fri Nem Pidatp: 1128! Notes: By Date Transporter 2 Print Name Type Of'DeAmctio By Date Transporter 3 Print Name Liners OH: Designated Facilities: Containers OH: Statewide Medical Services Darob, Inc. r 3601 East 9th Street 1801 Research Drive Arrive C Indianapolis, IN 46201 Louisville, KY 40269 Depa r f Service Time: 1=1 PAM PFA"INGHR (317) 634 0801 (502) 491 1535 U.S.D.O.T. 725204 .Certificate of Destruction: Cer ificati o receipt and de i f RMW mater'als covered by this mani e umb Signature Date 1 Original: Statewide Medical S ices 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 12/31/10 218846 Regulated Medical Waste 36.92 Total 36.92 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. Allowed 20 361011 Statewide Medical Services 3601 E. 9th St. Indianapolis, IN 46201 -2511 In Sum of 36.92 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1094 218846 4350900 36.92 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 27 -Jan 2011 WOAM&L Signature 36.92 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund