158651 04/15/2008 x
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: $41.50
INDPES IN 45201 -2511 CHECK NUMBER: 158651
CHECK DATE: 4115/2008
DEPARTME ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4350900 168484 41.50 OTHER CONT SERVICES
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1 111111 IIIII Illll IIIII IIIII IIIII IIII IIII
STATEWIDE MEDICAL SERVICES INVOICE
Full Service Medical Waste Disposal REC E l V
3601 East Ninth Street MAR 2 5 2008
Indianapolis, Indiana 46201-2511 Invoice Date Invoice
(3 17) 634 -0801 13 C 03/18/2008 168484
APR 2008 3 Invoice Due: 4/17/2008
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I�I��I�Il�sll,a,��ll��olall 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: Qty Lbs Rate Amount
03/12/2408 Regulated Medical Waste 4.5 Cu. Ft. #209235 1 Containers $38.50 $38.50
Box
03/12/2008 Energy Surcharge 209235 1 $3.00 $3.00
Total $41.50
Sales Tax $0.00
Total Invoice Due $41.50
`Total past due (See below) $0.00
`Total Current and past due $74.50
Minimum amount due now $0.00
Amount due 4/1712008 $41.54
Current and outstanding unpaid invoice history:
Invoice Date Current 30 -60 60 -90 90+
167582 2/29/2008 $33.00 $0.00 $0.00 $0.00
168484 3/18/2008 $41.50 $0.00 $0.00 $0.00
Totals $74.50 $0.00 $0.00 $0.00
DESTRUCTION CERTIFIED
Waste destroyed in accordance with all applicable
federal, state, and local regulations.
l o 04t, I S N(-
ACCOUNTS PAYABLE VOUCHER
f 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.
Statewide Medical Services
3601 East Ninth Street Date Due
Indianapolis, IN 46201 -2511
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/18108 168484 Medical waste service 41.50
Total 41.50
I hereby certify that the attached invoice(s), or bifl(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
Statewide Medical Services
3601 East Ninth Street
Indianapolis, IN 46201 -2511 In Sum of
41.50
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
.1047 168484 4350900 41.50 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
14 -Apr 2008
5' at Vr 4 1.50 Business Se es Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund