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Home My WebLink About204112 12/06/2011 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $6,334.65 CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV o� �0 101 N SENATE AVE CHECK NUMBER: 204112 INDIANAPOLIS IN 46206 -0847 CHECK DATE: 12/612011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4110000 110611 377.00 FULL TIME REGULAR 1115 4110000 110611 1,793.35 FULL TIME REGULAR 1125 4110000 110611 2,176.30 FULL TIME REGULAR 1207 4111000 110611 428.00 PART —TIME 601 5023990 110611 1,560.00 OTHER EXPENSES 133438 -1 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277 Toll free 1- 800 891 -6499 Marion County 232 -7436 STATEMENT OF BENEFIT CHARGES (FORM 535) CONFIDENTIAL RECORD PURSUANT TO IC 22 -4 -19.6, IC 4 -1 -66 Page 1 CITY OF CARMEL ACCOUNT/ ATTN CLERK TREASURER LOCATION NUMBER 133438 -000 ONE CIVIC SQ REPORTING MONTH OCT, 2011 CARMEL IN 46032 -2584 NET CHARGES $6 POSTING DATE NOV -06, 2011 The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for unemployment insurance since, before-an payments were made the employer had the opportunity. and the responsibility to report any information which could disqualify the claimant. SOC BENEFIT PAID FOR SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL I T DATE ENDING I ica CHARGED THIS IS NOT A BILL OR A REQUEST FOR MONEY DUE TO THIS DEPARTMENT. It is a statement of benefit charges made to your account during the "reporting" morph. At the end of the "posting" month, you will receive a Reimbursable Bill (Form 1067) for these charges and any previous liability still outstanding. NEW CHARGES FOR THE REPORTING MONTH 10 /11 K PHILLIPS 06/02/12 REG 10/30/11 10/29 /11' v 390.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 10 /11 6,467.95 REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 07/11 306 -72 -9034 C D BRADSHAW 04/07/12 REG 10/05/11 07/16/11 58.56CR CONTINUE ON NEXT PAGE An in the ACO column denotes a charge resulting from an acquisition of another business. Account /Location Number: 133438 000 Reporting Month: OCTOBER, 2011 Page 2 Employer Name: CITY OF CARMEL SOCIAL BENEFIT PAID FO SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACQ CHARGED REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 07/11 TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 07/11 58.56CR REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 12/08 M EDWARDS 10/31/09 REG 10/17/11 11/29/08 TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 12/08 74.74CR TOTAL AMOUNT OF NET CHARGES 6,334.65 END OF BENEFIT CHARGE STATEMENT �S �d v� An in the ACQ column denotes a charge resulting from an acquisition of another business. VOUCHER NO. WARRANT NO. ALLOWED 20 IN Department of Workforce Development Benefit Administration IN SUM OF 10 North Senate Avenue Indianapolis, IN 46204 -2277 $428.00 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1207 133438 00011- 41- 110.00 $428.00 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 Monday, November 28, 2011 Director, BrookshA Golf Club Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 199: ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or 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. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 11/06/11 133438 00011 -11 David Friesen Unemployment $428.0 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 113132 WARRANT ALLOWED 146500 IN SUM OF IN DEPT OF WORKFORCE DEVEL. 10 N. Senate Avenue, Ste 106 Indianapolis, IN 46204 Carmel dater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 1011 01- 4080 -12 $1,560.00 Voucher Total $1,560.00 Cost distribution ledger classification if claim paid under vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 146500 IN DEPT OF WORKFORCE REVEL. Purchase Order No. 10 N. Senate Avenue, Ste 106 Terms Indianapolis, IN 46204 Due Date 11/28/2011 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 11/28/201' 1011 $1,560.00 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 Date Officer 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. 146500 Indiana Dept. of Workforce Development Terms 10 North Senate Ave., SE 106 Date Due Indianapolis, IN 46204 -2277 Invoice Invoice Description Date !Number (or note attached invoice(s) or bill(s)) PO Amount 1116!11 133438 Unemployment charges City Acct/Parks Dept OcY11 2,176.30 Total 2,176.30 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. 146500 Indiana Dept. of Workforce Development Allowed 20 10 North Senate Ave., SE106 Indianapolis, IN 46204 -2277 In Sum of 2,176.30 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 1125 133438 4110000 2,176.30 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 1 -Dec 2011 Signature 2,176.30 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund