172558 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 361011 Page 1 of 1
'ONE CIVIC SQUARE STATEWIDE MEDICAL SERVICES
CARMEL, INDIANA 46032 3601 E 9TH ST CHECK AMOUNT: $36,92
INDPLS IN 46201 -2511 CHECK NUMBER: 172558
CHECK DATE: 5/13/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
,1047 4341999 188459 36.92 OTHER PROFESSIONAL FE
d
1 111111 VIII VIII VIII VIII VIII Illl 1111
STATEWIDE MEDICAL SERVICES INVOICE
Full Service Medical Waste Disposal
3601 East Ninth Street APR
Indianapolis, Indiana 46201-2511 7100 Invoice Date Invoice
(317) 634 -0801 04/24/2009 188459
Invoice Due: 5/24/2009
IIe�l�ll��ll�,�,�lls��l�ll Service Address:
CARMEL CLAY PARKS RECREATION CARMEL CLAY PARKS RECREATI
ATTN: ACCOUNTS PAYABLE 1411 E. 116TH ST.
1411 E. 116TH ST. CARMEL IN 46032 -3455
CARMEL IN 46032
-1-Account. Number:_ 1 3210 1 P.O..Number:. Terms: Net 30
Date Description Manifest Department Qty I Lbs Rate Amount
04/17/2009 Regulated Medical Waste 2.25 Cu. Ft. 239223 1 Containers $32.50 $32.50
Box
04/17/2009 Energy Surcharge 239223 1 $4.42 $4.42
Total $36.92
Sales Tax $0.00
Total Involce Due $36.92
*Total past due (See below) $0.00
*Total Current and past due $36.92
Minimum amount due now $O.0o
Amount due 5/24/2009 $36.92
Current and outstanding unpaid invoice history:
Invoice Date Current 30 -60 60 -90 90+
188459 4/2412009 $36.92 $0.00 $0.00 $0.00
Totals $36.92 $0.00 $0.00 $0.00
DESTRUCTION CERTIFIED
Waste destroyed in accordance with all applicable
federal, state, and local regulations.
n'1e i cQi Vj 0_ c-
a.r_
Bud A p c 8 .'009
une 1 I
]BY:.
V
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.
361011 Statewide Medical Services
3601 E. 9th St. Date Due
Indianapolis, IN 46201 -2511
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
4124109 188459 Regulated Medical Waste 20768 36.92
Total 36.92
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
361011 Statewide Medical Services
3601 E. 9th St.
Indianapolis, IN 46201 -2511 In Sum of
36.92
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1Q47 1AR45g
4 3 41000 3F 97 I h�.�h,. th ti i
�r by i.c hthy that tic a ac heu a 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
7 -May 2009
Signature
36.92 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I