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Home My WebLink About177523 09/28/2009 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of I ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $9,158.94 CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV 101 N SENATE AVE CHECK NUMBER: 177523 INDIANAPOLIS IN 46206-0847 CHECK DATE: 9/28/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 101 5023990 794.14 OTHER EXPENSES 1125 4110000 6,474.80 FULL TIME REGULAR X651 5023990 1,890.00 OTHER EXPENSES 1 1 133438 _1 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277 Toll flee 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 ATTN CLERKRTREASURE.R 1� �b"/ d ACCOUNT/ LOCATION NUMBER 13:3438 -000 ONE CIVIC SQ iP) i' REPORTING MONTH AUG, 2009 CARMEL IN 46032 25.84 t8 $9,158.94 NET CHARGES 0 POSTING DATE SEP -06, 200 The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for unemployment insurance since, before any payments were made the employer had the opportunity and the responsibility to report any information which could disqualify the claimant. SO CIAL BENEFIT .AID FOR SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING 1 ACj CHARGED THIS IS NOT A BILL OR A REQU. EST FOR .MONEY DUETO THIS DEPARTMENT. It is a statement of benefit charges made to your account during the "reporting" month. At the end of th:e' "posting" month, you will receive a Reimbursable Bill (Form 1067) for these charges and any previbus.liability still outstanding. NEW .CHARGES FOR THE REPORTING MONTH 08/09 0 R E BURY {I l`7 08/01/09 ;EB 08/26/09 04/25/09 54.9.4 08/02'/09 08/01/09: 17 is 3pg R K PETE J 07/03/10 REG. 08/31/09 08/20/09 X191 15? 3 J C MOREDOCK.IUL�� V 05/29/10 REG 08 /09/09 08/08/09 X102__62 3 3 A R BRITTAIN 06/05/10 'REG 08/02/09 08/01/09 F12 6'0Oa A R BRIT.TAIN M 06/05/10 REG 08/09/09 08/08/09 y 126 "'00? 3 4 A R BRITTAIN U v 06/05/10 REG 08/16/09 08/15/09 EIi A .R. BRITTAIN, 2� 06/05/10 REG 08/23/09 08/22/09 C,7q` 00` D D CAMPBELL• 05/15/1'0 REG 08/16/09 08/15/09 337.75 3 D__ D CAMPBELL 05/15/10 REG 08/23/09 08/22/09 384.56 S L AN DYKE C{in 10/31/09 REG 08/3.0/09 08/22/09 16.89 8 J C 07/03/10 REG 08/03/.09 08/01/09 03 00:1~ �J C'GUIEB 07/03/10 REG 08/09%09 06/08/09 F303_00 J C GUIEB 07/03/10 REG 08/19/09 08/15/09 3 I J C G 07/03/10 REG 08/26/09 08/22/09 �1_ •60-•_QM 3 !K NEFOUSE .1 02/06/10 RE G 08`0_3/_09 08 01/0• CT06.g5 33• 6 C M BRODERICK 04/04 09 EB 08/26/09 0.7/04/09 390700 33 6 C M BRODERICK 04 /04/09 EB 08/26/09 07/11/09 L390.00 3 8 C M BRODERICK 04/04/09 EB 08/26/09 07/18/09 390 3 8 C M BRODERICK 1 V 04/04/09 EB 08/26/09 07/25/09 -390:00; 8 C M BRODERICK �l 04/04/•09 EB 08/26/09 08/01/09 3 t_2_ 0 2 33 8 C M BRODERICK 04/04/09 EB 08/26/09 08/08/09 390_ 00� 3 C M BRODERICK 04/04/09 EB 08/26/0.9 08/15/09 390,: 3 C M BRODERICK. 04/04/09 EB 08/26/09 08/22 139p 00� 3 L S BAILEY 04 04 /U9 EB 08/26/09 06/27/09 1 8 93� L S BAILEY i(� v 04/04/09 EB 08/26/09 07/04/09 1 156 00 3 9 L S 'BAILEY i V 04/p4/09 EB 08/26/09 07/11/09 11 6 93 L S BAILEY 04/04/09 EB 08/26/09 07/18/09 156.00 L S BAILEY 04/04/09 EB 08/26/09 07/25/09 1'8:6.00 CONTINUE ON NEXT PAGE *5* A n the -ACQ column denotes a charge resulting from an acquisition of another business. �15L�] Accourit/Location Number: 133438 000 Reporting Month: AUGUST, 2009 Page 2 Employer dame: CITY OF CARMEL SOCIAL BENEFIT PAID FOR SECURITY YEAREND CLAIM RANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACC CHARGED NEW CHARGES FOR THE REPORTING MONTH 08/09 L S BAILEY 04/04/09 EB 08/26/09 08/01/09 X156:00:• 379 -76 3 L S BAILEY 04/04/09 EB 08/26/09 08/08/09 15`6 =00, L S BAILEY v 04104/09 EB 08/26/09 08/15/09 1 "56 OQ 37 78 ;793 L S BAILEY 04/04/.09 EB 08/26/09 08/22/09 156:00' -78 =793 L S BAILEY___ 04/04/.09 EB 08/30/09 08/29/09 156 =00 -10- 73 J G KOZLOVICH JR 106%05/10 REG 08 /03/09 08/01/0.9 378.0 -10- 273 J KOZLOVICH JR X06/05/10 REG 08/10/09 08/08/09 378.00 -10 3 J G KOZLOVICH JR �J 06/05/10 REG 08/16/09 08/15/09 378.00 0- '3 J G KOZLOVICH JR\ 06/05/10 REG 08/23/09 08/22/09 378.00 4- 0 J G KOZLOVICH JR 06/05/10 REG 08/31/09 08/29/09 378.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 08/09 9,158.94 TOTAL AMOUNT OF NET CHARGES 9,158.94 END OF BENEFIT CHARGE STATEMENT An in the ACQ column denotes a charge resulting from an acquisition of another business. 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)) Amount 9/6/09 133438 Benefit charge Aug'09 6,474.80 FAYEQLL;,OUT OF -101 er Michael 11'/20/08`` Total 6,474.80 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$ 6,474.80 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 1125 133438 4110000 6,474.80 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 24 -Sep 2009 AjJ_ 1 21J )1 )7?1 1 2nm Signature 6,474.80 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor 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 service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Indiana Department of Workforce Develo prTienPurchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Unemployment fo Doug Campbell $722.31 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. y 66RRANT NO. .!r ALLOWED 20 .Indiana Department of Workforce Development IN SUM OF Benefit Administration "1 0 NeFth Sei late Avenue is, 1N qfoZU4-2277 $722.31 ON ACCOUNT OF APPROPRIATION FOR GENERAL FUND 1201 Human Resources Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT I hereby ertify that the attached invoice(s), or DEPT. y 'y bill(s) is (are) true and correct and that the 1201 133438 100 722 or services itemized thereon for which charge is made were ordered and received except 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board qs Accounts City Form No. 201 (Rev. 1995) T 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. l A Pa I y l e y ee Vy V 1 N/ 1 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total I 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. ALLOWED 20 Y v IN SUM OF �qq 14 ON ACCOUNT OF'APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or I� 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 20 J/ Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF ARMEL ;Y C 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 DEVEL. Purchase Order No. Benefit Administration Terms 10 N. Senate Avenue Due Date 9/17/2009 Indianapolis, IN 46204 I1 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 9/17/2009 133438000 $1,890.00 hereby certify that the attached invoice(s), or bill(s) is (are) true and ;orrect and I have audited same in accordance with IC 5- 11- 10 -1.6 Date Officer VOUCHER 096404 WARRANT ALLOWED 146500 IN SUM OF IN- DEPT OF WORKFORCE DEVEL. Benefit Administration 10 N. Senate Avenue Indianapolis, IN 46204 Carmel Wastewater Utility ON ACCOUNT OF'APPROPRIATION FOR i Board members PO INV ACCT AMOUNT Audit Trail Code 133438000 01- 4080 -12 $1,890.00 Voucher Total $1,890.00 Cost distribution ledger classification if claim paid under vehicle highway fund