HomeMy WebLinkAbout157107 03/05/2008 CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1
z ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURIT AMOUNT: $120.00
CARMEL, INDIANA 46032 DIVISION OF ELEVATOR SAFETY
302 W WASHINGTON ST, RM E221 CHECK NUMBER: 157107
INDIANAPOLIS IN 46204
CHECK DATE: 3/512008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
X205 4350900 7675- 0218200 120.00 OTHER CONT SERVICES
r ELEVATOR OPERATING CERTIFICATE INVOICE
ARMEL PUBLIC WORKS SAFETY ONE CIVIC SQ CARMEL IN 46032
1.If Code An annual test report is due before a permit is issued.
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2.If Code A 5 year Test report is due before a permit is issued.
3.Over due fees must be paid before a permit is issued.
If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE
AFFIRMATION" form.
State No Code Due Over Due State No Code Due Over Due State No Code Due Over Due
45581 $120.00 o.o0 45582 $120.00 0.00 45583 $120.00 0.00
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Reference Number Invoice Date DETACH THIS STUB FOR YOUR RECORDS.
7675 02182008 02/18/2008 Unit(s) 3 Total Due upon receipt 360.00
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Return this part with payment
Ref.Num.:7675- 02182008 $360 Invoice Date 02/18/2008
If Paying by check, include a check made payable to the Department of Homeland
security. If Paying by Visa or Master Card, complete the following information and
return by mail :Indiana Department of Homeland Security, Fiscal Department, 302
W.Washington St., Rm E221,Indianapolis, IN 46204
or fax to (317)233 -0401. Questions? call(317)232 -6427 or
E- mail :elevator- invoice@dhs.in.gov:
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Full Name on Credit Card
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Billing Address: Street
City State Zip Code
Credit Card: Visa MasterCard ONLY (circle one)
Acct. Number Exp.Date (mm/yy)
CVV2 Number Contact Phone Number Signature
By signing, cardmember agrees to the obligations set forth by the Cardmember's
Agreement with the issuer. Detach this stub and mail it along with Payment.
I F A F 3 r a
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
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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
Department of Homeland Security Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
-02 /181% 7675- Elevator r@peratin i ica a invoice $120.00
Total $120
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.
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Clerk- Treasurer
VOUCHER N0 03ffi3f ffARRANT NO.
ALLOWED 20
D epartment of Homeland Security
IN SUM OF
Fiscal Department
302 W WaSnil lyton ree oom E2? 1
is, 4
$120.00
ON ACCOUNT OF APPROPRIATION FOR
GENERAL FUND
1205 Administration
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
DEPT.
bill(s) is (are) true and correct and that the
1205 7675- 02182008 509 00 materials or services itemized thereon for
which charge is made were ordered and
received except
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�y
Si tore
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund