169948 03/18/2009 CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURI
CARMEL, INDIANA 46032 DIVISION OF ELEVATOR SAFETY HECK AMOUNT: $360.00
302 W WASHINGTON ST. RM E221
CHECK NUMBER: 169948
INDIANAPOLIS IN 46204
CHECK DATE: 3/18/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DES
1205 4351501 7675- 0304200 360.00 EQUIPMENT MAINT CONTR
i
i
gin,
ELEVATOR OPERATING CERTIFICATE INVOICE
CARMEL PUBLIC WORKS SAFETY ONE CIVIC SQ CARMEL IN 46032
1.2f Code An annual test report is due before a permit is issued.
2.If Code A 5 year Test report is due before a permit is issued.
3.0ver due fees must be paid before a permit is issued.
If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE
AFFIRMATION" form.
State No Due Over Due Location Address
45581 $120.00 0.00 3 CIVIC SQ, CARMEL IN 46032
45582 $120.00 0.00 1 CIVIC SQ, CARMEL IN 46032
45583 $120.00 0.00 1 CIVIC SQ, CARMEL IN 46032
1
Reference Number Invoice Date DETACH THIS STUB FOR YOUR RECORDS.
7675 03042009 -1 03/04/2009 Unit(s) 3 Total Due upon receipt
of 3 360.00 of 360.00
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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Indiana Department of Homeland Security Purchase Order No.
r
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
03104/09- 7676 03042 L-1-21.E01 up0aung a e :mace $360.00
Total
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.
03/16 /0
ALLOWED 20
Indiana Dep artment of Homeland Sec urity
IN SUM OF
Fiscal Department
302 W. Washington Street, Room E221
Indianapolis, IN 46204
$360.00
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1205 Administration
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1205 767 5-0 10 42
$368-00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
041' Signature
[_f Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund