156642 02/21/2008 CITY OF CARMEL, INDIANA VENDOR: 146900 Page 1 of 1
d ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL M
CARMEL, INDIANA 46032 CASHIER'S OFFICE -MAIL CODE 50-100 HECK AMOUNT: $15,20D 00
100 N SENATE AVE
CHECK NUMBER: 156642
INDIANAPOLIS IN 46 207 -7060
CHECK DATE: 2/2112008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 80628 15,200.00 PERMIT
Ij
INVOICE
Please Remit To: Page: 1
INDIANA DEPT OF ENVIRONMENTAL MGMT Invoice No: 000080628
CASHIER OFFICE MAIL CODE 50 -10C Invoice Date: 01/02/2008
100 NORTH SENATE AVENUE Customer Number: CST100010357
INDIANAPOLIS IN 46204 Bill Type: 060
Payment Terms: NET 60
Due Date: 03/02/2008
Bill To:
CITY OF CARMEL
MR JOHN DUFFY -WATER DEPT AMOUNT DUE: 15,200.00 USD
1 CIVIC SQUARE
CARMEL IN 46032 -2584
Amount Remitted
Note Address Changes Above
For billing questions, please call 317 -233 0604
Line Ad Identifier Description Quantity UOM Unit Amt Net Amount
PLEASE NOTE NEW REMIT TO ADDRESS ABOVE.
This annual fee billing is required for active Public water Systems (to defray the costs of
administering activities of the federal Safe Drinking Water Act) under Indiana Code: IC 13 -18 -20.5.
To view via the internet, visit:
http: /www.IN.gov /legislative /ic /code /titlel3 /arl8 /ch2O.5.html
Fees are based on the activity status as of December 31 of the previous year.
Fees on Community water Systems will be based on the number of service connections on record'for
the- month• of December of- the -prior year
Fees are not pro- rated. If a system is sold or inactivated during the billingiyear, the,.amount,of
the assessed fee remains due and payable.
if payment of the assessed fee amount imposes an undue burden on the public water system, the
facility may notify this Agency within forty -five (45) days of this invoice date to pay in four
equal installments within a year.
Payments not received or received after the DUE date are subject to a delinquency charge equal to
10% of the assessed fee.
If several invoices are to be paid by one check, you MUST INCLUDE A COPY OF EACH BILLING INVOICE
in order to ensure proper credit for each fee assessment.
For questions regarding your assessed fee amount, please contact the Drinking Water Branch, Office
of Water Quality at 317/308 -3282.
ATTENTION: The due date shown in the upper right hand corner of this invoice reflects the
standard 60 days past the invoice print date.
1 08- IN5229004.0 -0 PWS Fee SVC:16000 1.00 15,200.00 15,200.00
TOTAL AMOUNT DUE 15,200.00
A copy of your invoice must be included with payment.
495 -IDEM Printed on Recycled Paper Original
k<OUCHER 074762 WARRANT ALLOWED
,146900 IN SUM OF
IN DEPT. OF ENVIRONMENTAL MGT.
P.O. BOX 7060
',NDIANAPOLIS, IN 46207 -7060
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
80628 01- 6750 -08 $15,200.00
i
Voucher Total $15,200.00
`Cast 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
146900
IN DEPT. OF ENVIRONMENTAL MGT. Purchase Order No,
P.O. BOX 7060 Terms
INDIANAPOLIS, IN 46207 -7060 Due Date 2/11/2008
1 nvoice I nvoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/11/2008 80628 $15,200.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
;orrect and I have audited same in accordance with IC 5- 11- 10 -1.6 S
Date Officer