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.
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 set forth by the Cardmember's
Agreement with the issuer.
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Department of Homeland Security
IN SUM OF
302 W. Washington, Rm E221
Indianapolis, IN 46204
$360.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. 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