163961 09/17/2008 CITY OF CARMEL, INDIANA VENDOR: 361011 Page 1 of 1
ONE CIVIC SQUARE STATEWIDE MEDICAL SERVICES CHECK AMOUNT: $36.92
CARMEL, INDIANA 46032 3601 E 9TH ST
INDPIS IN 46201 -2511 CHECK NUMBER: 163961
CHECK DATE: 911712008
DEPA A CCOUNT PO NUMBE INVOICE NUMBER AMOUNT D ESCRIPTION v
1047 W 4239012 176300 36.92 SAFETY SUPPLIES
STATEWIDE MEDICAL SERVICES INVOICE
Full Service Medical Waste Disposal
3601 East Ninth Street
Indianapolis, Indiana 46201-2511 Invoice Invoice Date Invoice
(317) 634 -0801 0811512008 176300
Invoice Due: 9114/2008
F E
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: 1 3210 P.O. Number: Terms: Net 30
Date Description Manifest Department Qty Lbs Rate Amount
08/08/2008 Regulated Medical Waste 2.25 Cu. Ft. 220594 1 Containers $32.50 $32.50
Box
08 /08 /2008 Energy Surcharge #220594 1 $4.42 $4.42
Total $36.92
Sales Tax $0.00
Total Invoice Due $36.92
A �otal past due (See below) $36.92
2��8 'Total Current and past due $110.76 I
BY: Minimum amount due now $36.92
Amount due 9/1412008 $36.
Current and outstanding unpaid invoice history:
tnvoice Date Current 30 -60 60 -90 90+
174000 6/30/2008 $0.00 $36.92 $0.00 $0.00 I CA
174888 7/18/2008 $36.92 $0.00 $0.00 $0.00
176300 8115/2008 $36.92 $0.00 $0.00 $0.00
Totals $73.84 $36.92 $0.00 $0.00
DESTRUCTION CERTIFIED
Waste destroyed in accordance with all applicable
federal, state, and local regulations.
PA ParF
&L# IOL477
B eR
Lie
Pumeheser
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 flue
Indianapolis, IN 46201 -2511
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/15/08 176300 Regulated 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 #rrITLE AMOUNT Board Members
Dept
1047 176300 4239012 36.92 l 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
28 -Aug 2008
l
Signature
36.92 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund