206221 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 366017 Page 1 of 1
ONE CIVIC SQUARE ENVIROCERT
CARMEL, INDIANA 46032 49 STATE STREET CHECK AMOUNT: $150.00
MARION NC 28752 CHECK NUMBER: 206221
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2200 4355300 150.00 ORGANIZATION MEMBER
C E R T I F I E D
Municipal Separate
Storm. Sewer System
DUMP NO WASTE
CMS4S Renewal Notice L�
m
2012 2013 SS�`
S P E C I A
JOHN GHARRITY THOMAS Amount Due: $75.00
11576 CREEK SIDE LANE Date Due: March 31, 2012
CARMEL, IN 46033 RETURN THIS FORM WITH YOUR PAYMENT
Renewal Fee Details:
C,%ISrrs# 139 ...........A QutC. ,,75.VV Years: i .............Aiiwurit vac. ,iJ.vv...... Status: Active Status:
Professional Development Affirmation:
Current Period: 3/23/2011- 3/22/2013 I..................... Requirement: 20 PDUs per 2 Year Period
Review your training records and select either YES or NO in response to the following statement:
I HAVE COMPLETED PROFESSIONAL DEVELOPMENT REQUIREMENTS FOR THE CURRENT PERIOD: RYES NO
Sign and date in the space below. (See back page for explanation.)
John Gharrity Thomas Date
Information Update (Please mark this notice with any changes to your contact information.)
Business Phone: (317) 571 -2314
Ext.
Fax: (317) 571 -2439
Home Phone: (317) 815 -1196
Email: jthomas @carmel.in.gov
Please list any professional titles that you currently hold (for example, PE, RLA):
Payment Information
ENTER YOUR PAYMENT INFORMATION ON THE REVERSE SIDE OFTHIS NOTICE.
49 STATE STREET (MARION, NC 28752 PHONE: 828.655.1600 FAX: 828.655.1622 www.Cms4S.ORG
AN ENVIROCERT INTERNATIONAL, INC. AFFILIATED PROGRAM
Erosion
Sediment
Storm Water
LESS I ene al N -6tice
r C S I
2 ®12 ®13
j 'I N S' 'P E C`'`T 0 R.
KURT-MAXWELLANDERSON AmountuDue $75 00-
ONE CIVICSQUARE'
Date Dd Ma.rch'3i.:, Zo�i'
DEPARTMENT OF,ENGINEERING•'°
CARM ELp I N' 46032; RETURN THIS FORM WITH YOUR PAYMENT' f
RenewaIT" e• Details
Rat e:.$ oo .Ye Aroil t due: ov ��a'cus: fictive
Professional Development Affirmation
Current_ Penod: 3I cl? t 31z2�zoi3 Requirement zo PD per z Year Period' i
Review your teaming records and select either YES' or NO.in.response to the following statement.
HAVE COMPLETED PRO FESSIONAL'DEVELOPMENT:;REQUI REM ENTS FOR THE:CURRENT PERIOD [2 <ES :13 NO-:
Sign and date in the space (See back
ack- ige for-explanati6m)
�j
Kurt:Mazwell Anderson; bate
Information Update. (Please mark this nofice with any changes to your contact Information
Business Phone �.z- 08
(3 7) 57 3
Ext w
fax (317) 57t?;439 �I
Home- Phone::(3t7) 44-074
Email. kanderson(a Carmel In .goy
Please list anv,orofessional titles that you currenflv.h0lr1 (for examnla PF Al
Payment, Inform ation
ENTER YOU I NFORMATION ON THE REVERSE S IDE OF THIS NOTICE;:" "t
I
A
r 49 STATE STREET MARION;, NC 28752, PHONE .828 655.1600 FAX 828 655 1622 .WWW.CESSWI.ORG
CTS P WQ'
�an..a,,. AN ENVIROCERT INTERNATIONAL, INC: PROGRAM. "w eY're
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
Envirocert
Purchase Order No.
49 State Street
Terms
Marion, NC 28752
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
CMS4S renewal (John Thomas) $75.00
CeSSWI renewal (Kurt Anderson)
I
Y
Total $1500
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.
Enviro _rt
ALLOWED 20
49 Rtate Street IN SUM OF
Marion, NC 28752
$150.00
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
n/a 2200- 4355300 $75.00 bill(s) is (are) true and correct and that the
2200 4355300 $75.00 materials or services itemized thereon for
which charge is made were ordered and
received except
2 2 20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund