162058 07/23/2008 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
INDPLS IN 46201.2511 CHECK NUMBER: 162058
1
CHECK DATE: 7/23/2008
DEPARTMENT ACCOUN PO NUMBER INVOICE NUMBER A MOUNT D ESCRIPTION
1047 4239012 173332 36.92 SAFETY SUPPLIES
r.•
STATEWIDE MEDICAL SERVICES INVOICE
Full Service Medical Waste Disposal
3601 East Ninth Street
Indianapolis, Indiana 46201 -2511 Invoice Date Invoice
(317) 634 -0801 06/19/2008 173332
Invoice Due: 7/19/2008
.JUN 2 3 2008
I
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 1 Lbs Rate Amount
06/13/2008 Regulated Medical Waste 2.25 Cu. Ft. 215908 1 Containers $32.50 $32.50
Box
06/13/2008 Energy Surcharge 215908 1 $4.42 $4.42
Total $36.92
Sales Tax $0.00
Total Invoice Due $36.92
'Total past due (See below) $0.00
I 'Total Current and past due $73.37
Minimum amount due now $0.00
Amount due 7/19/2008 $36.92
Current and outstanding unpaid invoice history:
Invoice Date Current 30 -60 60 -90 90+
172284 5/30/2008 $36.45 $0.00 $0.00 $0.00
173332 6119/2008 $36.92 $0.00 $0.00 $0.00
Totals $73.37 $0.00 $0.00 $0.00
DESTRUCTION CERTIFIED
Waste destroyed in accordance with all applicable
federal, state, and local regulations.
JUL 0 2 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
;1
361011 Statewide Medical Services Purchase Order No.
3601 E. 9th St.
Indianapolis, IN 46201 -2511 Date Due
Invoice Invoice
Date Description
Number (or note attached invoice(s) or bill(s))
6119/08 173332 Regulated Medical Waste Amount
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 Total 36.92
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 173332 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
18 -Jul 2008
Signature
36.92 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund