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Home My WebLink About168043 01/21/2009 :F 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: $480.00 302 W WASHINGTON ST, RM E221 CHECK NUMBER: 168043 INDIANAPOLIS IN 46204 CHECK DATE: 1/2112009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1047 4350100 734241120320 240.00 BUILDING REPAIRS MA 1047 4350100 734241123120 240.00 BUILDING REPAIRS MA t. t�� 5T47��1 STATE OF INDIANA w s� DEPARTMENT OF HOMELAND SECURITY /ELEVATOR DIVISION January 14, 2009 CARMELlCLAY BOARD OF PARKS RECREATION 1411 E 116TH ST Ref.Number 734241 CARMEL IN 46032 If you have questions concerning your equipment, please call 317- 232 -2670. Past Due Payment Information Our records indicate that the payments in the attached invoice(s) are past due. Please send all payments p inquiries to: Department of Homeland Security 302 W. Washington St. Rm. E243 /Fiscal Dept. Indianapolis, IN 46204 Phone: 317- 232 -2150 Fax number: 317 -233 -0401 Email: elevator- invoice @dhs.in.gov "Method of payment as follows: -Check -Money Order -Visa or Mastercard ONLY_no exceptions (credit card form enclosed with letter) "Make all checks payable to: Department of Homeland Security Debra Jackson Director Elevator Amusement Safety Division Indiana Department of Homeland Security 1 of 2 a 4 4, p OVERDUE INVOICE CARMEUCLAY BOARD OF PARKS RECREATION 1411 E 116TH ST CARMEL IN 46032 Ref.Number: 734241 Fee Due: 120.00 Elevator Total Count: 1 Invoice Date 1212012007 State Number Location Address 111703 1235 CENTRAL PARK DR EAST, ,CARMEL,IN,40632 Note If the above elevator(s) are not in service or have been removed please contact our office for an "ELEVATOR OUT OF SERVICE AFFIRMATION" form. If Paying by check, include a check made payable to the Department of Homeland Security, If Paying by Visa or Master Card, complete the following information and mail or fax to (317)233 -0401: Full Name on Credit Card Billing Address: Street City State Zip Code Credit Card: Visa I MasterCard ONLY (circle one) Acct. Number Exp,Date (mm /yy) CVV2 Number Contact Phone Number By signing, cardmember agrees to Signature the obligations setforth by the Cardmember's Agreement with the issuer. Mail /Fax the 1st page of this notice along with Payment. 2 of 2 ELEVATOR OPERATING CERTIFICATE INVOICE CARM /CLAY BOARD PARKS RECREATION 1411 E 116TH ST CARMEL IN 46032 l.If 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.Over 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 111703 $120.00 120.00 1235 CENTRAL PARK DR EAST, CARMEL IN 40632 Purchase F l n Description r P.O.# PorF B u d Une et JAN 0 6 2009 Purchaser Date Approval Dat Reference Number Invoice Date DETACH THIS STUB FOR YOUR RECORDS. 734241 12312008 -1 12/31/2008 Unit(s) 1 Total Due upon receipt of 1 240.00 of 240.00 ELEVATOR OPERATING CERTIFICATE INVOICE CARMEL /CLAY BOARD OF PARKS RECREATION 1411 E 116TH ST CARMEL IN 46032 1.If 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.Over 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 111704 $120.00 0.00 1235 CENTAL PARK DR EAST, CARMEL IN 46032 111978 $120.00 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 40632 Purchase Oes«ipUon P.O. P ndF a.LR une DEC 1 2 2008 Purchaser Date i Approval L D-mE JL U Reference Number Invoice Date DETACH THIS STUB FOR YOUR RECORDS. 734241 12032008 -1 12/03/2008 Unit(s) 2 Total Due upon receipt of 2 240.00 of 240.00 CARMEL /CLAY BOARD OF PARKS RECREATION 1411 E 116TH ST CARMEL IN 46032 1.if 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. 11 State No Due Over Due Location Address 1 111704 $120.00 0.00 1235 CENTAL PARK DR EAST, CARMEL IN 46032 111978 $120.00 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 40632 Puxche A P.O. J C� a.�.9 4 35 P DEC 1 2008 A FC Bu raw Purcho-W T— Date APPrOval Reference Number Invoice Date DETACH THIS STUB FOR YOUR RECORDS. 734241- 12032008 -1 12/03/2008 Unit(s) 2 Total Due upon receipt of 2 240.00 of 240.00 Return this part with payment Ref.Num.:734241- 12032008 $240 of 240.00 Invoice Date 12/03/2008 If Paying by check, include a check made payable to the Department of Homeland security. If Paying by Visa or Master Card, .complete the following information and return by mail :Indiana Department of Homeland Security, Fiscal Department, 302 W.Washington St., Rm E221,Indianapolis., IN 46204 or fax to (317)233 -0401. Questions? call(317)232 -6427 or E- mail :elevator- invoice@dhs.in.gov: Full Name on Credit Card Billing Address: Street City State Zip Code Credit Card: Visa MasterCard ONLY (circle one) Acct. Number Exp.Date (mm /yy) CVV2 Number Contact Phone Number Signature By signing, cardmember agrees to the obligations set forth by the Cardmember's Agreement with the issuer. Detach this stub and mail it along with Payment. v 1 i ELEVATOR OPERATING CERTIFICATE INVOICE GARMEL /CLAY BOARD OF PARKS RECREATION 1411 E 116TH ST C AR M EL IN 46032 1.If 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.Over 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 111703 $120.00 120.00 1235 CENTRAL PARK DR EAST, CARMEL IN 40632 7 Purchase Description Qp •Fj P.O.# f1 PorF Bud get N line Descx ,P o Purchaser Date Approval I Date L l Reference Number Invoice Date DETACH THIS STUB FOR YOUR RECORDS. 734241 12312008 -1 12/31/2008 Unit(s) 1 Total Due upon receipt i of 1 240,00 of 240.00 I r i Return this part with p a yment Ref.Num.:734241- 12312008 1 $240 of 240,00 Invoice Date 12 /31/2008 If Paying by check, include a check made payable to the Department of Homeland security. If Paying by Visa or Master Card, complete the following information and return by mail :Indiana Department of Homeland Security, Fiscal Department, 302 W.Washington St., Rm E221,Indianapolis, IN 46204 or fax to (317)233 -0401. Questions? call(317)232 -6427 or E- mail:elevator- invoice@dhs in.gov: j Full Name on Credit Card I Billing Address: Street City State Zip Code Credit Card: Visa MasterCard ONLY (circle one) Acct. Number Exp.Date (mm /yy) CVV2 Number Contact Phone Number Signature By signing, cardmember agrees to the obligations set forth by the Cardmember's ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL p 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. Department of Homeland Security Terms Fiscal Department 302 W Washington St., Rm E221 Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoices) or bill(s)) Amount 1213!08 734241 12032008 -1 Elevator operating permit 240.00 12/31/08 734241- 12312008 -1 Elevator operating permit 240.00 Total 480.00 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. Dep rtment of Homeland Security Allowed 20 Fiscal Department 302 W Washington St., Rm E221 Indianapolis, IN 46204 In Sum of 480.00 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund POW or INVOICE NO. ACCT #fTITLE AMOUNT Board Members Dept 1047 734241- 12032ma -1 4350100 240.00 1 hereby certify that the attached invoice(s), or 1047 734241- 12312008 -1 4350100 240.00 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 6 -Jan 2009 Signature 480.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund 1