162995 08/20/2008 CITY OF CARMEL, INDIANA VENDOR: 361011 Page 1 of 1
ONE CIVIC SQUARE STATEWIDE MEDICAL SERVICES CHECK AMOUNT: $73.84
CARMEL, INDIANA 46032 3601 E 9TH ST
INDPLS IN 46201 -2511 CHECK NUMBER: 162995
CHECK DATE: 8/20/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4239012 174000 36.92 SAFETY SUPPLIES
1047 4239012 174888 36.92 SAFETY SUPPLIES
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STATEWIDE MEDICAL SERVICES INVOICE
Full Service Medical Waste Disposal
3601 East Ninth Street Tw-,
Indianapolis, Indiana 46201 -2511 32Qa� Invoice Date Invoice
(317) 634 -0801 07/18/2008 174888
Invoice Due: 8/17/2008
$y:
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: Net 30
Date Description Manifest Department Qtv Lbs Rate Amount
07/11/2008 Regulated Medical Waste 2.25 Cu. Ft. 218545 1 Containers $32.50 $32.50
Box
07/11/2008 Energy Surcharge 218545 1 $4.42 $4.42
Total $36.92
Sales Tax $0.00
Total Invoice Due $36.92
,Total past due (See below) $0.0
!'Total Current and past due $110.76
Minimum amount due now $0.00
Amount due 8/17/2008 $36.92
Current and outstanding unpaid invoice history:
Invoice Date Current 30 -60 60 -90 90+
173332 6/19/2008 $36.92 $0.00 $0.00 $0.00
174000 6/30/2008 $36.92 $0.00 $0.00 $0.00
174888 7118/2008 $36.92 $0.00 $0.00 $0.00
Totals $110.76 $0.00 $0.00 $0.00
DESTRUCTION CERTIFIED
Waste destroyed in accordance with all applicable
federal, state, and local regulations.
I
STATEWIDE MEDICAL SERVICES INVOICE
Full Service Medical Waste Disposal
3601 Fast Ninth Street
Indianapolis, Indiana 46201-2511 Invoice Date Invoice
(317) 634 -0801 06/30/2008 174000
Invoice Due: 7/30/2008
Service Address:
CARMEL CLAY PARKS RECREATION.R q} CARMEL CLAY PARKS RECREATI
ATTN: ACCOUNTS PAYABLE 1411 E. 116TH ST.
1411 E. 116TH ST. JUL 0 7 2008 CARMEL IN 46032 -3455
CARMEL IN 46032
Account Numberj 3210 P.O. Number: Terms: Net 30
Date Description Manifest Department Qty Lbs Rate Amount
06/27/2008 Regulated Medical Waste 2.25 Cu. Ft. 217486 1 Containers $32.50 $32.50
Box
06/27/2008 Energy Surcharge 217486 1 $4.42 $4.42
Total $36.92
Sales Tax $0.00
Total Invoice Due $36.92
'T otal past due (Se b elow) $36.45
Total Current and past due
Minimum amount due now $36.45
Amount due 7/30/2008 $36.92
Current and outstanding unpaid invoice history:
Invoice Date Current 30 -60 60 -90 90+
172284 5/30/2008 $0.00 $36.45 $0.00 $0.00
173332 6/19/2008 $36.92 $0.00 $0.00 $0.00
174000 6/30/2008 $36.92 $0.00 $0.00 $0.00
Totals $73.84 $36.45 $0.00 $0.00
R-EcTN ED
DESTRUCTION CERTIFIED JUL 2 9 2008
Waste destroyed in accordance with all applicable
federal, state, and local regulations. BY:
Z4 I A6 �'Z,
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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
7118108 174888 Regulated Medical Waste 36.92
7130/08 174000 Regulated Medical Waste 36.92
Total 73.84
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
73.84
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#1TITLE AMOUNT Board Members
Dept
1047 174888 4239012 36.92 1 hereby certify that the attached invoice(s), or
1047 174000 4239012 36.92 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
18 -Jul 2008
1 p bj whTUML��
Signature
73.84 Accounts Payable Coordinatdr
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund