166902 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 361011 Page 1 of 1
ONE CIVIC SQUARE STATEWIDE MEDICAL SERVICES CHECK AMOUNT: $34.42
j CARMEL, INDIANA 46032 3601 E 9TH ST
INDPLS 1N 46201 -2511 CHECK NUMBER: 166902
CHECK DATE: 12/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4239099 180363 34.42 OTHER MISCELLANOUS
I
1 111111 IIIII IIIII IIIII IIIII IIIII IIII IIII
STATEWIDE MEDICAL SERVICES INVOICE
Full Service Medical Waste Disposal
3601 East Ninth Street
Indianapolis, Indiana 46201-2511 REGE Invoice Date Invoice
(317) 634 -0801 NO V 520 10/31/2008 180363
Invoice Due: 11/30/2008
Service Address:
CARMEL CLAY PARKS RECREATION CARMEL CLAY PARKS RECREATI
ATTN: ACCOUNTS PAYABLE 1411 E. 116TH ST.
1411 E. 116TH ST. CARMEL IN 46032 -3455
CARMEL IN 46032
Account_ Number:_ -3210. P.O. Number: Terms: I Net 30
Date Description Manifest Department: Qty Lbs Rate Amount
10/31/2008 No Waste Wasted Trip Charge 227192 1 $30.00 $30.00
10/31/2008 Energy Surcharge #227192 1 $4.42 $4.42
Total $34.42
Sales Tax $0.00
Total Invoice Due $34.42
*Total past due (See below) 1 $0.00
`Total Current and past due $71.34
Minimum amount due now $0.00
Amount due 11/30/2008 $34.42
Current and outstanding unpaid invoice history:
Invoice Date Current 30 -60 60 -90 90+
179148 10/1012008 $36.92 $0.00 $0.00 $0.00
180363 10/31/2008 $34.42 $0.00 $0.00 $0.00
Totals $71.34 $0.00 $0.00 $0.00
DESTRUCTION CERTIFIED
Waste destroyed in accordance with all applicable
federal, state, and local regulations.
Purchase
Descript►on► i' --J D �l Q, Z 7 c� fp�
7
P at
Bud et
DEC p 1 2008
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)) Amount
10/31/08 180363 Regulated Medical Waste 34.42
Total 34.42
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
34.42
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 180363 4239099 34.42 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
3 -Dec 2008
Signature
34.42 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund