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Home My WebLink About199803 08/02/2011 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CARMEL, INDIANA 46032 DEVELOPMENT ATTN� ACCT RECV CHECK AMOUNT: $8,375.25 101 N SENATE AVE CHECK NUMBER: 199803 INDIANAPOLIS IN 46206 -0847 CHECK DATE: 812!2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4110000 1,560.00 FULL TIME REGULAR 1120 4110000 1,560.00 FULL TIME REGULAR 1125 4110000 2,915.25 FULL TIME REGULAR 1192 4110000 1,560.00 FULL TIME REGULAR 601 5023990 780.00 UNEMPLOYMENT 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 JUN, 2011 CARMEL IN 46832 -2584 NET CHARGES $8,375.25 POSTING DATE JUL 2{311 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 I CLAIM �T RANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE I ENDING I ACO 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 06/11 J M PENN 10 16 10 EB CONTINUE ON NEXT PAGE An in the ACQ column denotes a charge resulting from an acquisition of another business. Account /Location Number: 1334.38 000 Reporting Month: JUNE, 2011 Page 2 Employer Name: CITY OF CARMEL SOCIAL BENEFIT PAID FOR SECURITY YEAR END CLAIM �T RANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACQ CHARGED NEW CHARGES FOR THE REPORTING MONTH 06/11 J M PENN 10/16/10 EB 06/27/11 06/25/11 172.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 06/11 8,375.25 TOTAL AMOUNT OF NET CHARGES 8,375.'25 The following charge(s) are POTENTIAL credits to your account. A determination was made and you were found not liable for these charges. But.because you have chosen to make payment in lieu of contributions for Unemployment Insurance, your account cannot be credited for these charges unless or until the claimant(s) refund the overpayment. Your account will be credited as the claimant refunds the overpayment in full or in monthly installments. 315 -08 -2658 K NEFOUSE 02/11/12 REG 04/02/11 204.86 END OF BENEFIT CHARGE STATEMENT TV CS 6 �C- q An in the ACQ column denotes a charge resulting from an acquisition of another business. VOUCHER NO. WARRANT NO. ALLOWED 20 Indiana Department of Workforce Development IN SUM OF 10 North Senate Avenue Indianapolis, IN 46204 $1,560.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 I 133438 I 41- 100.00 I $1,560.00 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 AUG .4 20H Fire Chief 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)) 133438 I I $1,560.00 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 NO. ALLOWED 20 Indiana Department of Workforce Development Benefit Administration IN SUM OF 10 North Senate Avenue Indianapolis, IN 46204 -2277 $1,560.00 ON ACCOUNT OF APPROPRIATION FOR Carmel DOCS PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1192 I I 41- 100.00 I $1,560.00 1 hereby certify that the attached invoice(s), or bills) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Friday, July 29, 2011 Director 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)) 06/01/11 Unemployment Trudy $1,560.00 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 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., SE 106 Date Due Indianapolis, IN 46204 -2277 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount .7/3/11 133438 Unemployment charges Jun'11 2,915.25 Total 2,915.25 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 1 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 2,915.25 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 1125 133438 4110000 2,915.25 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 26 -Jul 2011 Signature 2,915.25 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund i I VOUCHER NO. WARRANT NO. Indiana Department of Workforce Development ALLOWED 20 Benefit Administration IN SUM OF 10 North Senate Avenue Indianapolis, IN 46204 -2277 $1,560.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# f Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members $1,560.00 1110 41- 100.00 I hereby certify that the attached invoice(s), or I 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, July 28, 2011 Chief of Police 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)) 07/27/11 payment for unemployment for Greg Park $1,560.00 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 111895 WARRANT ALLOWED 146500 IN SUM OF IN DEPT OF WORKFORCE DEVEL. 10 N. Senate Avenue, Ste 106 Indianapolis, IN 46204 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 0611 01- 4080 -12 $780.00 Voucher Total $780.00 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 146500 IN DEPT OF WORKFORCE DEVEL. Purchase Order No. 10 N. Senate Avenue, Ste 106 Terms Indianapolis, IN 46204 Due Date 7/25/2011 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 7/25/2011 0611 $780.00 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