173795 06/24/3009 CITY OF CARMEL, INDIANA VENDOR: 362497 Page 1 of 1
0 ONE CIVIC SQUARE DEPARTMENT OF HOMELAND SECURITY
CARMEL, INDIANA 46032 BOILER AND PRESS. VALVE SAFETY DIV CHECK AMOUNT: $75.00
302 W WASHINGTON ST, RM 246
oµ t o CHECK NUMBER: 973795
INDIANAPOLIS IN 46204-2739
CHECK DATE: 6/24/2009
DEPARTMENT ACCOUNT PO NUMBER INVOI NUMBER AMOUNT DESCRIPTION
1110 4350100 222697 25.00 BUILDING REPAIRS MA
1110 4350100 222698 25.00 BUILDING REPAIRS MA
1110 4350100 288872 25.00 BUILDING REPAIRS MA
r��
FSTATe INVOICE FOR INSPECTION CERTIFICATE FEES
o 4 ti lr Lo
State Form 356 (R4 9 -93)
Approved by the State Board of Accounts 1991
s Division of Fire and Building Safety
1. Marl checks payable to DEPARTMENT OF HOMELAND SECURITY
INSTRUCTIONS: 2. Mail 2nd copy check to DEPARTMENT OF HOMELAND SECURITY
Boiler and Pressure Vessel Safety Division
302 W WASHINGTON ST., RM 246
INDIANAPOLIS IN 46204 -2739
Telephone: (317) 232 -1921
LATEST
INVOICE PLEASE
INDIANA DATE
PAY THIS
NUMBER AMOUNT[
CARMEL CITY OF
222698 3 CIVIC SO 06/12/2009
CARMEL, IN 46032
Fee
User Name Location of vessel POLICE DEPT
Owner number
3 CIVIC SQ
CARMEL IN 46032 25.00
Serial number Description of vessel Manufacturer Date Last Inspected
AIR TANK /AIR AFTER- COOLER /AIR FILTER WOOD IND 05/27/2009
National Board No. Inspection agency Name of inspector (This fee is
5557840 TRAVELERS CALHOUN JOSEPH S prescribed by
IC 22- 12 -6 -10)
`r
Y INVOICE FOR INSPECTION CERTIFICATE FEES
4
State Form 356 (R4 19 -93)
1 i Approved by the State Board of Accounts 1991
n Division of Fire and Building Safety
Te' a 1. Mail checks payable to DEPARTMENT OF HOMELAND SECURITY
2. Maii 2nd copy check to DEPARTMENT OF HOMELAND SECURITY
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division
302 W WASHINGTON ST., RM 246
INDIANAPOLIS IN 46204 -2739
Telephone: (317) 232 -1921
INDIANA LATEST PLEASE
NUMBER INVOICE PAY THIS
CARMEL CITY OF DATE AMOUNT!
288872 3 CIVIC SQ
CARMEL, IN 46032 06/].2/2009 i
Owner number User Name Location of vessel POLICE DEPT Fee V
3 CIVIC SQUARE 25.00
CARMEL IN 46032
Serial number Description of vessel Manufacturer Date Last Inspected
SERVICE WATER HEATER LOCHINVAR 05/27/2009
National Board No. inspection agency Name of inspector (This fee is
TRAVELERS CALHOUN JOSEPH S prescribed by
IC 22- 12 -6 -10)
Inspection Date Inspector Name Inspection Type Due
05/27/2009 CALHOUN JOSEPH S RE- INSPECTION -B- 288872,06/12/2009 25.00
INVOICE FOR INSPECTION CERTIFICATE FEES
RECEIVED
State Form 356 (R419 -93)
Approved by the Slate Board of Accounts 1991
Division of Fire and Building Safety
JUN 17 2009
ai6 1. Mail checks payable to DEPARTMENT OF HOMELAND SECURITY
2. Mail 2nd copy check to DEPARTMENT OF HOMELAND SECURITY
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division CARMEL POLICE DEPT"
302 W WASHINGTON ST., RM 246
INDIANAPOLIS IN 46204 -2739
Telephone: (317) 232 -1921
INDIANA CARMEL CITY OF LATEST PLEASE
NUMBER C/O M. FOGARTY INVOICE PAY THIS
DATE AMOUNT!
222697 3 CIVIC SQ
CAP-MEL, IN 46032 06/12/2009 d
Owner number User Name Location of vessel POLICE DEPT Fee
651680 3 CIVIC SQ 25.00
CARMEL IN 46032
Serial number Description of vessel Manufacturer Date Last Inspected
ELECTRIC BOILER /STEAM GENERATOR BRASCH 05/27/2009
National Board No. Inspection agency Name of inspector (This fee is
815 TRAVELERS CALHOUN JOSEPH S prescribed by
IC 22- 12 -6 -10)
Inspection Date Inspector Name Inspection Type Due
05/27/2009 CALHOUN JOSEPH S RE- INSPECTION -B- 222697,06/12/2009 25.00
'v
A�s1R,F° INVOICE FOR INSPECTION CERTIFICATE FEES
State Form 356 (R4 9 -93)
a? p i'= Approved by the State Board of Accounts 1991
Division of Fire and Building Safety
7a;e 1. Mail checks payable to DEPARTMENT OF HOMELAND SECURITY
2, Mail 2nd copy check to DEPARTMENT OF HOMELAND SECURITY
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division
302 W WASHINGTON ST., RM 246
INDIANAPOLIS IN 46204 -2739
Telephone: (317) 232-1921
INDIANA LATEST PLEASE
NUMBER CARMEL CITY OF INVOICE PAYTHIS
DATE AMOUNT.
222698 3 CIVIC SQ
CARMEL, IN 46032 06/12/2009
Owner number User Name Location of vessel POLICE DEPT Fee
3 CIVIC SQ 25.00
CARMEL IN 46032
Serial number Description of vessel Manufacturer Date Last Inspected
I AIR TANK /AIR AFTER- COOLER /AIR FILTER WOOD IND 05/27/2009
National Board No. Inspection agency Name of inspector (This fee is
_557840 TRAVELERS CALHOUN JOSEPH S prescribed by
C 22- 12 -6 -10)
Inspection Date Inspector Name Inspection Type Due
05/27/2009 CALHOUN JOSEPH S RE- INSPECTION -U- 222698,06/12/2009 25.00
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
D epartment of Homeland Security Purchase Order No.
Boiler and Pressure Vessel Safety Division
302 W. Washington Street, Room 246 Terms
Indianapolis, IN 46204-2739
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6/12/09 288872 payment for inspection of service water heater 25.00
6/12/09 222697 payment for inspection of eleectric boiler steam gen 25.00
6/12/09 222698 payment for inspection of air tank /air after cooler/ 25.00
air filter
Total 75.00
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.
ALLOWED 20
D epartment of Homeland Security IN SUM OF
Boiler and Pressure Vessel Safet y Division
302 W. taashington Street, Room 246
I ndianapolis, IN 46204 -2739
75.00
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 222698 501 25.00 bill(s) is (are) true and correct and that the
1170 222697 501 25.00 materials or services itemized thereon for
1110 288872 501 25.00 which charge is made were ordered and
received except
June 17 2009
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund