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Home My WebLink About198880 07/05/2011 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $10,993.83 CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV 101 N SENATE AVE CHECK NUMBER: 198880 INDIANAPOLIS IN 46206 -0847 CHECK DATE: 7/5/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4110000 3,120.00 FULL TIME REGULAR 1115 4110000 1,612.63 FULL TIME REGULAR 1120 4110000 1,950.00 FULL TIME REGULAR 1125 4110000 3,141.20 FULL TIME REGULAR 1192 4110000 1,170.00 FULL TIME REGULAR Account /Location Number: 133438 000 Reporting Month: MAY, 2011 Page 2 Employer Name: CITY OF CARMEL SOCIAL BENEFIT PA OR SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING AGO CHARGED NEW CHARGES FOR THE REPORTING MONTH 05/11 J M PENN 10 /16 /10 EB 05/31/11 05/28/11 172.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 05/11 10,993.83 TOTAL AMOUNT OF NET CHARGES 10,993.83 END OF BENEFIT CHARGE STATEMENT ACS= i An in the ACQ column denotes a charge resulting from an acquisition of another business. i I I 133438 -1 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277 Toll free 1- 800 891 -6499 Marlon County 232 -7436 STATEMENT OF BENEFIT CHARGES (FORM 535) CONFIDENTIAL RECORD PURSUANT TO IC 22- 4 -19 -6, IC 4 -1 -66 Page 1 CITY OF CARMEL ACCOUNT/ ATTN CLERK TREASURER LOCATION NUMBER 133438 -000 ONE CIVIC SQ REPORTING MONTH MAY, 2011 CARMEL IN 46032 2584 NET CHARGES $10 ,993.83 POSTING DATE JUN -03, 2011 The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for unemployment insurance since, before any payments were made the employer had the opportunity and the responsibility to report any information which could di "squalify the claimant. SOCIAL BENEFIT PAID FOR SECURITY YEAR END I CLAIM TRANSACTION WEEK AMOUNT NUMBER I EMPLOYEE'S NAME DATE LEVEL DATE ENDING AC Q CHARGED THIS IS NOT A BILL OR A REQUEST FOR MONEY DUE TO THIS DEPARTMENT. It is a statement of benefit charges made to your account during the "reporting" month. At the end of the "posting" month, you will receive a Reimbursable Bill (Form 1067) for these charges and any previous liability still outstanding. NEW CHARGES FOR THE REPORTING MONTH 05/11 K L COOPER 03/03/12 REG 05/d8/11 05/07/11 17.00 CONTINUE ON NEXT PAGE An r) in the ACQ column denotes a charge resulting from an acquisition of another business. i 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 'I nvoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 06/06/11 Unemployment Trudy $1,170.00 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 20 Clerk- Treasurer VOUCH NO. WARRANT NO. ALLOWED 20 Indiana Department of Workforce Development Benefit Administration IN SUM OF 10 North Senate Avenue Indianapolis, IN 46204 -2277 $1,170.00 ON ACCOUNT OF APPROPRIATION FOR Carmel DOCS PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1192 41- 100.00 $1,170.00 I 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 Thursday, June 30, 2011 o Title Cost distribution ledger classification if claim paid motor vehicle highway fund 133438 -1 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277 Toll free 1- 800 891 -6499 Marion County 232 -7436 STATEMENT OF BENEFIT CHARGES (FORM 535) CONFIDENTIAL RECORD PURSUANT TO IC 22- 4 -19 -6, IC 4 -1 -66 Page 1 CITY OF CARMEL ACCOUNT/ ATTN CLERK TREASURER LOCATION NUMBER 133438 -000 ONE CIVIC SQ REPORTING MONTH MAY, 2011 CARMEL IN 46032 2584 NETCHARGES $10 ,993.83 POSTING DATE JUN-031 2011 The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for unemployment insurance since, before any payments were made the employer had the opportunity and the responsibility to report any information which could disqualify the claimant. SOCIAL BENEFIT PAID FOR SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING I ACQ CHARGED THIS IS NOT A BILL OR A REQUEST FOR MONEY DUE TO THIS DEPARTMENT. It is a statement of benefit charges made to your account during the "reporting" month. At the end of the "posting" month, you will receive a Reimbursable Bill (Form 1067) for these charges and any previous liability still outstanding. NEW CHARGES FOR THE REPORTING MONTH 05/11 K L COOPER 03/03/12 REG 05/08/11 05/07/11G 17.00 CONTINUE ON NEXT PAGE An in the ACQ column denotes a charge resulting from an acquisition of another business. r Account /Location Number: 133438 000 Reporting Month: MAY, 2011 Page 2 Employer Name: CITY OF CARMEL SOCIAL BENEFIT PAID FOR SECURITY YEAR END I CLAIM TRANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACO CHARGED NEW CHARGES FOR THE REPORTING MONTH 05/11 J M PENN 10/16/10 EB 05/31/11 05/28/11 172.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 05/11 10,993.83 TOTAL AMOUNT OF NET CHARGES 10,993.83 END OF BENEFIT CHARGE STATEMENT i 61rn J�t2 3 rv? x (41.7 An in the ACQ column denotes a charge resulting from an acquisition of another business. 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)) $1,950.00 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 VOUCHER NO. WARRANT N ALLOWED 20 Indiana Department of Workforce Development IN SUM OF 10 North Senate Avenue Indianapolis, IN 46204 $1,950.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. I ACCT #/TITLE AMOUNT Board Members 1120 I I 41- 100.00 I $1,950.00 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 JUL I .011 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund 133438 -1 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277 Toll free 1- 800 891 -6499 Marion County 232 -7436 STATEMENT OF BENEFIT CHARGES (FORM 535) CONFIDENTIAL RECORD PURSUANT TO IC 22- 4 -19 -6, IC 4.1 -66 Page 1 CITY OF CARMEL ACCOUNT/ ATTN CLERK TREASURER LOCATION NUMBER 133438 -000 ONE CIVIC SO REPORTING MONTH MAY, 2011 CARMEL IN 46032 2584 NET CHARGES $10 ,993.83 POSTING DATE JUN-03, 2011 The receipt of this statement.(Form 535) does not. reopen the question of the claimant's eligibility for unemployment insurance since, before any payments were made the employer had the opportunity and the responsibility to report:any information which could disqualify the claimant. SOCIAL BENEFIT PAID FOR SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING A CHARGED THIS 1S NOT A BILL OR A REQUEST FOR MONEY DUE TO THIS DEPARTMENT. It is a statement of benefit charges made to your account during the "reporting" month. At the end of the "posting" month, you will receive a Reimbursable Bill (Form 1067) for these charges and any previous liability still outstanding. NEW CHARGES FOR THE REPORTING MONTH 05/11 K L COOPER 03/03/12 REG 05/08/11 05/07/11 17.00 CONTINUE ON NEXT PAGE An in the ACQ column denotes a charge resulting from an acquisition of another business. Account /Location Number: 133438 -000 Reporting Month: MAY, 2011 Page 2 Employer Name: CITY OF CARMEL SOCIAL BENEFIT PAID FOR SECURITY I I YEAR END I CLAIM TRANSACTION I WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACQ CHARGED NEW CHARGES FOR THE REPORTING MONTH 05/11 J M PENN 10/16/10 EB 05/31/11 05/28/11 172.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 05/11 10,993.83 TOTAL AMOUNT OF NET CHARGES 10,993.83 END OF BENEFIT CHARGE STATEMENT rn J Uf, 2011 BY: An in the ACQ column denotes a charge resulting from an acquisition of another business. 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. 146500 Indiana Dept. of Workforce Development Terms 10 North Senate Ave., SE106 Date Due Indianapolis, IN 46204 -2277 Invoice Invoice Description Date Number or note attached invoice(s) or bill(s)) PO Amount D 613111 133438 Unem to ment char es Ma '11 3,141.20 Total 3,141.20 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. 146500 Indiana Dept. of Workforce Development Allowed 20 10 North Senate Ave., SE106 Indianapolis, IN 46204 -2277 In Sum of 3,141.20 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 1125 133438 4110000 3,141.20 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 pa 28 -Jun 2011 Signature 3,141.20 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund