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Home My WebLink About180676 12/29/2009 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE !i CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV CHECK AMOUNT: $10,821.59 101 N SENATE AVE CHECK NUMBER: 180676 INDIANAPOLIS IN 46206 -0847 CHECK DATE: 12/29/2009 D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 101 5023990 133438 -000 13.16 OTHER EXPENSES 1120 4110000 133438 -000 1,950.00 FULL TIME REGULAR 1125 4110000 133438 -000 3,297.93 FULL TIME REGULAR -1201 4110000 133438 -000 1,950.00 FULL TIME REGULAR `1207 4111000 133438 -000 1,720.50 PART -TIME 651 4110000 133438 -000 1,890.00 FULL TIME REGULAR 'K 133438 -1 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277 Toll free 1- 600 -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 NOV, 2009 CARMEL IN 46032 -2584 NET CHARGES $1.0,821.59 POSTING DATE DEC -04, 2009 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. S05 BENEFIT PAID FOR SECURITY YEAR END I CLAIM TRANSACTION I WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACO 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" month. At the end of the "posting" month, you will receive a Reimbursable Bill (Form 1067) for these charges and any previous liability still outstanding. NEI FOR THE REPORTING MONTH 11/09 E O EDEDUWA 07/25/09 EB 11/09/09 10/31/09 97.50 /l E 0 EDEDUWA 07/25/09 EB 11/12/09 11/07/09 L 7�1� 97,50 E 0 EDEDUWA 07/25/09 EB 11/17/09 11/14/09 97. D M JENSEN 08/28/10 REG 11/04/09 10/31/09 250.00 b 1 D L LLOYD 09/25/10 REG 11/02/09 10/31/09 3� �✓128.00 l0 l� D L LLOYD 09/25/10 REG 11 /10/09 11/07/09 95.30 R S BLAIR 09/19/09 EB 11/08/09 10/31/09 6.68 Lj R.S BLAIR 09/19/09 EB 11/08/09 11/07/09 l�. 6.48 U J N SPENCE 10/23/10 REG 11/18/09 11/07/09 168.00 J N SPENCE 10/23/10 REG 11/23/09 11/14/09 168.00 J N SPENCE 10/23/10 REG 11/25/09 11/21/09 168.00 I J N SPENCE 10/23/10 REG 11/29/09 11/28/09 168.00 R K PETE 07/03/10 REG 11/30/09 11/26/09 .122.63 I0 M A MONTGOMERY 08/14/10 REG 11/04/09 10/31/09 357.00 M A MONTGOMERY 08/14/10 REG 11/10/09 11/07/09 357.00 n M A MONTGOMERY 08/14/10 REG 11/16/09 11/14/09 357.00 K U M 'A MONTGOMERY 08/14/10 REG 11/24/09 11/21/09 357.00 3 D M LINGELBAUGH 09/18/10 REG 11/01/09 10/31/09 390.00 D M LINGELBAUGH 09/18/10 REG 11/08/09' 11/07/09 0390.00 D M LINGELBAUGH 09/16/10 REG 11/15/09 11/14/09 1 9. 390.00 D M LINGELBAUGH 09/18/10 REG 11/22/09 11/21/09 390.00 3 D M LINGELBAUGH 09/18/10 REG 11/29/09 11/28/09 390.00 C M BRODERICK 04/04/09 EB 11/02/09 10/31/09 390.00 3 C M BRODERICK 04/04/09 EB 11/10/09 11/07/09 U C M BRODERICK 04/04/09 EB 11/17/09 11/14/09 11 390.00 J L HOPE 08/14/10 REG 11/04/09 10/31/09 390.00 J L HOPE 08/14/10 REG 11/11/09 11/07/09 390.00 -42 -4 J L HOPE 08/14/10 REG 11/16/09 11/14/09 1� 390.00 J L HOPE 08/14/10 REG 11/24/09 11/21/09 `"1 390.00 CONTINUE ON NEXT PAGE An in the ACO column denotes a charge resulting from an acquisition of another business. Accouht/Location Number: 133438 000 Reporting Month: NOVEMBER, 2009 Page 2 Employer Name; CITY OF CARMEL SOCIAL BENEFIT PA FOR SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING I ACO CHARGED ARGES FOR THE REPORTING MONTH 11/09 5 J L HOPE 08/14/10 REG 11/30/09 11/28/09 390,00 J M PENN 10/16/10 REG 11/04/09 10/31/09 172.00 3$° J M PENN 10/16/10 REG 11/09/09 11/07/09 172.00 53 -23- J M PENN 10/16/10 REG 11/16/09 11/14/09? 172.00 -2 J M PENN 10/16/10 REG 11/23/09 11/21/09 172.00 J M PENN 10/16/10 REG 11/30/09 11/28/09 172.00 '4 lrl -5Y27 J G KOZLOVICH JR 06/05/10 REG 11/02/09 10/31/09 378.00 J G KOZLOVICH JR 06/05/10 REG 11/09/09 11/07/09 378.00 J G KOZLOVICH JR 06/05/10 REG 11/19/09 11/14/09 U 378.00 J G KOZLOVICH JR 06/05/10 REG 11/22/09 11/21/09 1 C 378.00 J G KOZLOVICH JR 06/05/10 REG 11/30/09. 11/28/09 378.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 11/09 10,821.59 TOTAL AMOUNT OF NET CHARGES 10,621.59 END OF BENEFIT CHARGE STATEMENT 7 )-0- S Ion 02,00 or s 1 CZ� f X10' o An in the ACQ column denotes a charge resulting from an acquisition of another business. Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 IN Dept.of.Workforce Developmen Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 12/04/09 133438 -000 Unemployment Charge 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. IZ, WARRANT NO. ALLOWED 20 IN Dept of Workforce Developme IN SUM OF 10 N. Senate Av Indi anapolis, IN 46204 $1,950.00 ON ACCOUNT OF APPROPRIATION FOR General Fund 12 01 Human Resources Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or DEPT. bill(s) is (are) true and correct and that the 1201 133438 -000 100 $1,950.00 materials or services itemized thereon for which charge is made were ordered and received except 20 Si natur Title Cost distribution ledger classification if claim paid motor vehicle highway fund ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of bi11 to be properly itemized must show; kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. 146500 Indiana Dept. of Workforce Development Terms 10 North Senate Ave., SE106 Date Due Indianapolis, IN 46204 -2277 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/4109 133438 Benefit charge Nov'09 3,297.93 PAY;ALL OUT_OF101,perM�cF,ael #11. 120108 Total 3,297.93 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 1 20 Clerk- Treasurer +v ;Voucher No. Warrant No. 146500 Indiana Dept. of Workforce Development Allowed 20 10 North Senate Ave., SE 106 ti Indianapolis, IN 46204 -2277 In Sum of$ 3,297.93 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 1125 133438 4110000 3,297.93 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 28 -Dec 2009 V Signature 3,297.93 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund Pr(�ribed 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 Purchase Order No. /'D V&ej Terms 1AA)i 141,/, LtUs f lJ CA�2fi 4� Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) j�tb f �YIG�AL Qs ;7 l' k n J P Total� pO ra I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same Waccordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. +r H ALLOWED 20 1AJ v F Wo k 'LN vie NM 2r� IN SUM OF b NO N s t4 &P- A--tj-e- NFL, ON ACCOUNT OF APPROPRIATION FOR clf v o Gia �elt,0 %yea P��tLC�d(Q� Board Members Po# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT- I hereby certify that the attached invoice(s), or -�,111eo 00 jclS 6 o- 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 i ature E- F Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 4 dA64 urchase Order No. /ZZ�l/1T� ,�2, }2 t24,t�1, Terms zL2 o il k s/_ Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 56 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. i ALLOWED 20 IN SUM OF U ,J fiwo S, 226' �d ON ACCOUNT OF APPROPRIATION FOR 6 WEe"q 1 C Uv Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or Z?v, -5'o bill(s) is (are) true and correct and that the p 13. I(, materials or services itemized thereon for v j which charge is made were ordered and received except 20 o N r ignat0fe itle Cost distribution ledger classification if claim paid motor vehicle highway fund VOUCHER 097042 WARRANT ALLOWED 1%16500 IN SUM OF IN DEPT OF WORKFORCE DEVEL. Benefit Administration 10 N. Senate Avenue India napolis, IN 46204 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR 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 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 DEVEL. Purchase Order No. Benefit Administration Terms 10 N. Senate Avenue Due Date 12/30/2009 Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/3012005 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