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HomeMy WebLinkAbout195484 03/16/2011 CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURITI' AMOUNT: $360.00 .�o CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY- FISCAL OFF! -ao 302 w WASHINGTON ST, RM E221 CHECK NUMBER: 195484 INDIANAPOLIS IN 46204 CHECK DATE: 3116!2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4351501 7675 0301201 120.00 EQUIPMENT MAINT CONTR 1205 4351501 7675 0301201 240.00 EQUIPMENT MAINT CONTR ELEVATOR OPERATING CERTIFICATE INVOICE CARMEL PUBLIC WORKS SAFETY ONE CIVIC SQ 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 permit 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 45581 $120.00 0.00 3 CIVIC SQ, CARMEL IN 46032 45582 $120.00 0.00 1 CIVIC SQ, CARMEL IN 46032 45583 $120.00 0.00 1 CIVIC SQ, CARMEL IN 46032 L-1 D MAR 14 2011 By Reference Number Invoice Date Please submit ENTIRE document with payment 7675 03012011 -1 03/01/2011 Unit(s) 3 Total Due upon receipt of 3 360.00 of 360.00 Ref.Num.:7675- 03012011 -1 $360 of 360.00 Invoice Date 03/01/2011 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,Indianapolis, 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. 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ACCT #fTITLE AMOUNT Board Members 1205 7675 03012011 43- 515.01 $240.00 1 hereby certify that the attached invoice(s), or I 0 7675- 03012011 43- 515.01 $120.00 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, March 14, 2011 Director, Ad inistratio Title Cost distribution ledger classification if claim paid motor 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)) 03101111 7675 03012011 $240.00 03/01/11 1 7675 03012011 $120.00 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