HomeMy WebLinkAbout195889 03/29/2011 CITY OF CARMEL, INDIANA VENDOR: 362497 Page 1 of 1
0 ONE CIVIC SQUARE DEPARTMENT OF HOMELAND SECURIT&ECK AMOUNT: $25.00
CARMEL, INDIANA 46032 BOILER AND PRESS VALVE SAFETY DIV
on ,o 302 W WASHINGTON ST, RM 246 CHECK NUMBER: 195889
INDIANAPOLIS IN 46204 -2739
CHECK DATE: 3/29/2011
DEP ARTMENT A CCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 04935 25.00 O'T'HER EXPENSES
INVOICE FOR INSPECTION CERTIFICATE FEES
State Form 356 (R4 9 -93)
Approved by the State Board of Accounts 1991
Division of Fire and Building Safety
tlg
1. Mail checks payable to DEPARTMENT U'� HONWLANID !_-C IJRITY
INSTRUCTIONS: 2. Mail 2nd copy check to DEPARTMENT OF HOMELAND SECURITY
Boiler and Pressure Vessel Safety Division
302 W WASHINGTON ST, RM 246
INDIANAPOLIS IN 46204 -2739
Telephone: (317) 232 -1921
LATEST
INVOICE
I DATE ^PLEASE
INllIANA
CARMEL CITY OF PAY THIS
NCIIIHER I AMOUNT]
C/O LISA KEMPA
,308699 760 3RD AVE SW SUITE 110 103/11/2012 J --j
CARAMEL, IN 46032
User Name Location of vessel CARMEL WASTE WTR UTILITIES Pee
Owner number j
Serial number -I- CARME IN D ELL
46280 KhY Manufacturer v Date Last Inspected 00
Description of vessel p
FT Boiler HURST 02/22/2011
National Board No Inspection agency Name of inspector (This fee is
14935 TRAVELERS CALHOUN -'OSEP13 S prescribed by
675 IAC 12 -3 -13)
VOUCHER 107414 WARRANT ALLOWED
362497 IN SUM OF
DEPARTMENT OF HOMELAND SECUF
BOILER AND PRESSURE VESSEL SAF
302 W WASHINGTON ST RM 246
INDIANAPOLIS, IN 4
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
04935 01- 7750 -08 $25.00
Voucher Total $25.00
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
362497
DEPARTMENT OF HOMELAND SECURITY Purchase Order No.
BOILERAND PRESSURE VESSEL SAFETY DI% Terms
302 W WASHINGTON ST RM 246 Due Date 3/28/2011
INDIANAPOLIS, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/28/2011 04935 $25.00
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
Date Officer