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Home My WebLink About200123 08/03/2011 CITY OF CARMEL, INDIANA VENDOR: 361011 Page 1 of 1 `l. ONE CIVIC SQUARE STATEWIDE MEDICAL SERVICES CHECK AMOUNT: $75.84 CARMEL, INDIANA 46032 3601 E 9TH ST INDPLS IN 46201 -2511 CHECK NUMBER: 200123 CHECK DATE: 8/3/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1094 4350900 227700 37.92 OTHER CONT SERVICES 1094 4350900 228183 37.92 OTHER CONT SERVICES STATEWIDE MEDICAL SERVICES INVOICE Full Service Medical Waste Disposal 3601 East Ninth Street Indianapolis, Indiana 46201-2511 Invoice Date Invoice (3 17) 634 -0801 06/30/2011 227700 JUL 0 b 20 Invoice Due: 7/30/2011 BY; Service Address: CARMEL CLAY PARKS RECREATION CARMEL CLAY PARKS RECREATI ATTN: ACCOUNTS PAYABLE MONON CENTER 1411 E. 116TH ST. 1235 CENTRAL PARK EAST CARMEL IN 46032 CARMEL IN 46032 -3455 Account Number: 3210 P.O. Number: Tern Net 30 Date Description Manifest Department: Qty Lbs Rate Amount 06/24/2011 Regulated Medical Waste 2.25 Cu. Ft. 298978 1 Containers $32.50 $32.50 Box 06/24/2011 Energy Surcharge 298978 1 $5.42 $5.42 Total $37.92 Sales Tax $0.00 Total Invoice Due $37.92 DESTRUCTION CERTIFIED Waste destroyed in accordance with all applicable federal, state, and local regulations. Purchase Description R CC A- LA D r) EbICA L k AST, P.O.# PorF G.L. 1Gg4 t4- 35O9c)O Budget Line Descr Qkr (Sf j 5yrs Purchaser_ Date Approval pate STATEWIDE MEDICAL SERVICES INVOICE Full Service Medical Waste Disposal 3601 East Ninth Street't(��+ Indianapolis, Indiana 46201-2511 211 Invoice Date Invoice (3 17) 634 -0801 JUL 07/12/2011 228183 Invoice Due: 8/11/2011 Service Address: CARMEL CLAY PARKS RECREATION CARMEL CLAY PARKS RECREATI ATTN: ACCOUNTS PAYABLE MONON CENTER 1411 E. 116TH ST. 1235 CENTRAL PARK EAST CARMEL IN 46032 CARMEL IN 46032 -3455 Account Number: 1 3210 P.O. Number: Terms: I Net 30 Date Description Manifest Department: Qty Lbs Rate Amount 07/01/2011 Regulated Medical Waste 2.25 Cu. Ft. 299521 1 Containers $32.50 $32.50 Box 07/01/2011 Energy Surcharge 299521 1 $5.42 $5.42 Total $37.92 Sales Tax $0.00 Total Invoice Due $37.92 DESTRUCTION CERTIFIED Waste destroyed in accordance with all applicable federal, state, and local regulations. Purchase REC�L. TED I CAL WA�Si Description P.O.# PorF G.L. 10g4 L135r)9()()_ Budget Line Descr 6) 7& S'VCS Purchaser Date Approval Date BIOHAZARDOUS WASTE MANIFEST Hazardous Materials Bill of Lading ei SPILL EMERGENCIES ONLY: 800 535 -5053 Manifest Number Generator Shl p er of Waste: Trans orter of Waste: CARNIFI. CLAY PARKS RECREATION Name Statewide Medical Services Darob, Inc. 235 CENTRAL PARK EAST 3601 East 9th Street 1801 Research Drive Address Indianapolis, IN 46201 Louisville, KY 40269 (317) 634 -0801 (502) 491 -1535 City 3 2 3433 t� U.S.D.O.T. 725204 Zip Contact Account Number County Telephone (317) 573 -5250 Weekly UN3291, REGULATED MEDICAL WASTE, n.o.s., 6.2, PG II Customer P/U Hours: I Container Size Ouantit Received Weight Monday: 2.25 Cu. Ft. Box 1 Tuesday: Wednesday: Thursday: Friday: Generator (Shipper) Certification: Transporter (Consignee) Certification: This is to certify that the here -in -named materials are properly This is to certify that the here -in -named materials are properly classified, described, packaged, marked, labeled, and are in classified, described, packaged, marked, labeled, and are in proper condition for transportation according to applicable proper condition for transportation according to applicable regulations of the U.S. Department of Transportation. regulations of the U.S. Department of Transportation. Materials will be destroyed in accordance with all applicable local, state By f Date 7Tl and federal regulations. Signature of authorized representative of waste generator. B Date Print Name 41 transporter 1 Route INOY NW-A Last P/U 06/24120 Print Name E1 Week Fri Nesti ndav: 7/812011 Notes: By Date Transporter 2 Print Name Type Of Destructio By Date Transporter 3 Print Name Liners OH: Designated Facilities: Containers OH: Statewide Medical Services rob, Inc. 3601 East 9th Street 1801 Research Drive Indianapolis, IN 46201 Louisville, KY 40269 Arrive Depart Service Time: (317) 634 -0801 (502) 491 -1535 PAMPFA"INGER U.S.D.O.T. 725204 Certificate of Destruction: Certifica 'on r cei n estru io of RMW materials covered by this manifest numbe Signature Date Original: Statewide Medical Services op Gene o o Waste Certificate of Destruction to Accompany Invoice 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. 361011 Statewide Medical Services 3601 E. 9th St. Date Due Indianapolis, IN 46201 -2511 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 6/30/11 227700 Regulated Medical Waste 37.92 7/12/11 228183 Regulated Medical Waste 37.92 To 75.84 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 361011 Statewide Medical Services 3601 E. 9th St. Indianapolis, IN 46201 -2511 In Sum of 75.84 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept 1094 227700 4350900 37.92 1 hereby certify that the attached invoice(s), or 1094 228183 4350900 37.92 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 4�1//wu Signature 75.84 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund