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Home My WebLink About200637 08/17/2011 CITY OF CARMEL, INDIANA VENDOR: 361011 Page 1 of 1 ONE CIVIC SQUARE STATEWIDE MEDICAL SERVICES 11 CARMEL, INDIANA 46032 3601 E 9TH ST CHECK AMOUNT: $75.84 INOPLS IN 46201 -2511 CHECK NUMBER: 200637 CHECK DATE: 811712011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1094 4350900 228758 37.92 OTHER CONT SERVICES 1094 4350900 228980 37.92 OTHER CONT SERVICES 111111 IIIII IIIII IIIII VIII IIIII IIII IIII STATEWIDE MEDICAL SERVICES INVOICE Full Service Medical Waste Disposal 3601 East Ninth Street Indianapolis 46201 -2511 Invoice Date Invoice (3 17) 634 -0801 07/27/2011 228980 Invoice Due: 8/26/2011 I�I��I�II��II� „sell��lell 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. Nu Terms: Net 30 Date Description Manifest Department: Qty Lbs Rate Amount 07/2212011 Regulated Medical Waste 2.25 Cu. Ft. 301057 1 Containers $32.50 $32.50 Box 07/22/2011 Energy Surcharge 301057 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 1�1 JUL 2 1011 P.o. P or F G.L. 1.099- LA 350900 Line D Line escr Purchaser Date Approval Date BIOHAZARDOUS WASTE MANIFEST Hazardous Materials Bill of Lading �AA7 SPILL EMERGENCIES ONLY: 800 535 -5053 Manifest Number Generator (Shipper) of Waste: Trans po ter of Waste: Name CARAIEL CLAY PARKS RECREATION MONON CENTER [I Statewide Medical Services Darob, Inc. 1235 Cam PARK EAST 3601 East 9th Street 1801 Research Drive Address Indianapolis, IN 46201 Louisville, KY 40269 (317) 634 -0801 (502) 491 -1535 City CA S' State IN U.S.D.O.T. 725204 Zip 46032- Contact CARREKEAVENEY Account Number 3210 County Telephone (317) 573 -5250 Weekly UN3291, REGULATED MEDICAL WASTE, n.o.s., 6.2, PG II Customer P/U Hours: Container Size -Quantity-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 p per condition for transportation according to applicable proper condition for transportation according to applicable egulea ons 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 00-t-� Date and federal regulations. -7 Signature of authorized re r sentative of waste generator. `f Print Name C r r v n ea By Date Trans or r 1 Route INDY -�l'A Last /U 0711512011 Print Name Y-4— Notes: ElWeek F ri Next Pi&v: 7129/2011 By Date Transporter 2 Print Name L e Of Destmctio BY Date Transporter 3 Print Name Liners OH: Designated Facilities: Containers OH: Statewide Medical Services Darob, Inc. f 3601 East 9th Street 1801 Research Drive Arrive: Depar Service Time: Indianapolis, IN 46201 Louisville, KY 40269 (317) 634 -0801 (502) 491 -1535 PAMPFAFFINGER U.S.D.O.T. 725204 Certificate of Destruction: Certification of receipt and d tr o M ials covered by this nwifest number: Signature Date Original: Statewide Medical Services Copy: Generator of aste ertificate of Destruction to Accompany Invoice l IIIIII VIII VIII VIII VIII VIII I'll Illl STATEWIDE MEDICAL SERVICES INVOICE Full Service Medical Waste Disposal 3601 East Ninth Street Indianapolis, Indiana 46201-2511 Invoice Date Invoice (3 17) 634 -0801 07/25/2011 228758 Invoice Due: 8/24/2011 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 1P.O.Num Terms: Net 30 Date Description Manifest Department: Qty Lbs Rate Amount 07/15/2011 Regulated Medical Waste 2.25 Cu. Ft. 300537 1 Containers $32.50 $32.50 Box 07/15/2011 Energy Surcharge 300537 1 $5.42 $5.42 Total $37.92 Sales Tax $0.00 r y Total Invoice Due $37.92 BY: DESTRUCTION CERTIFIED Waste destroyed in accordance with all applicable federal, state, and local regulations. Purchase ry� Description �E,&L TAD KAEUCAL W ��F P.O.# PorF G.L.# 109LA 43S0goco Budget Line Descr l�dJ1 l.,U 1 Purchaser Date Approval Date 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 note attached invoice(s) or bill(s)) PO Amount 7125111 228758 RMedical Wa ste 37'92 7/27/11 228980 u Medical Waste 37'92 Total 75.84 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 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 228758 4350900 37.92 1 hereby certify that the attached invoice(s), or 1094 228980 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 9 -Aug 2011 Signature 75.84 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund