164946 10/16/2008 CITY OF CARMEL, INDIANA VENDOR: 361011 Page 1 Of 1
ONE CIVIC SQUARE STATEWIDE MEDICAL SERVICES
CARMEL, INDIANA 46032 3601 E 9TH ST CHECK AMOUNT: $36.92
INDPLS IN 46201 -2511 CHECK NUMBER: 164946
CHECK DATE: 10/16/2008
DEPARTMENT ACCOU PO NUMBER INVOIC NUMBER AMOUNT DESCRIPTION
1047 4239012 177886 36.92 SAFETY SUPPLIES
j
m
STATEWIDE MEDICAL SERVICES T I NV OI CE
Full Service Medical Waste Disposal�
3601 East Ninth Street
Indianapolis, Indiana 46201 -2511 SEP Invoice Date Invoice
(317) 634 -0801 09/18/2008 177886
Invoice Due: 10/18/2008
�e�eele��ee�'eeeeelleee� ell 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: I Terms: Net 30
Date Description Manifest Department: Qty Lbs Rate Amount
09/05/2008 Regulated Medical Waste 2.25 Cu. Ft. #222665 1 Containers $32.50 $32.50
Box
09/05/2008 Energy Surcharge 222665 1 $4.42 $4.42
Total $36.92
Sales Tax $0.00
OCT 0 2 2008 Total Invoice Due $36.92
'Total past due (See below) $36.92
BY: 'To tal Current and past due $73.84
Minimum amount due now $36.92
Amount due 10/18/2008 $36.92
Current and outstanding unpaid invoice history:
Invoice Date Current 30 -60 60 -90 90+
176300 8/15/2008 $0.00 $36.92 $0.00 $0.00
177886 9/18/2008 $36.92 $0.00 $0.00 $0.00
Totals $36.92 $36.92 $0.00 $0.00
DESTRUCTION CERTIFIED
Waste destroyed in accordance with all applicable 1 Q
federal, state, and local regulations.
T
Purchase 17 q2-39 0 i Z-
Description
P.O.0 G P or F
�.L !OI 2-
Budget
Una
Elrte
Purchat�'
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
9118108 177886 Re ulated Medical Waste 36.92
Total 36.92
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
36.92
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 177886 4239012 36.92 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
6 -Oct 2008
Signature
36.92 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund