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Home My WebLink About171095 04/16/2009 CITY OF CARMEL, INDIANA VENDOR: 361011 Page 1 of 1 ti ONE CIVIC SQUARE STATEWIDE MEDICAL SERVICES CARMEL, INDIANA 46032 3601 E 9TH ST CHECK AMOUNT: $73.84 INDPLS IN 46201 -2511 CHECK NUMBER: 171095 CHECK DATE: 4/16/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1047 4341999 183130 36.92 OTHER PROFESSIONAL FE 1047 4341999 185749 36.92 OTHER PROFESSIONAL FE it III1111111111111111111111101111101111011 STATEWIDE MEDICAL SERVICES INVOICE Full Service Medical Waste Disposal 3601 East Ninth Street RECEIVED Indianapolis, Indiana 46201-2511 Invoice Date Invoice (3 17) 634 -0801 .IAN 0 6 2009 12/31/2008 183130 BY. Invoice Due: 1/30/2009 lels�loll�ell��II��1011 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 Account Number: 32 10 P.O._Number: Terms:. Net 30. Date Description Manifest Department: Qty Lbs Rate Amount 12/26/2008 Regulated Medical Waste 2.25 Cu. Ft. 230905 1 Containers $32.50 $32.50 Box 12/26/2008 Energy Surcharge 230905 1 $4.42 $4.42 Total $36.92 Sales Tax $0.00 Total Invoice Due $36.92 'Total past due (See below) $0.00 *Total Current and past due $36.92 Minimum amount due now $0.00 Amount due 1/30/2009 $36.92 Current and outstanding unpaid invoice history: Invoice Date Current 30 -60 60 -90 90+ Purchase 183130 12/31/2008 $36.92 $0.00 $0.00 $0.00 Description Totals $36.92 $0.00 $0.00 $0.00 P.0-# or F G.L `f -71 11P 3 !7 9- DESTRUCTION CERTIFIED and et Waste destroyed in accordance with all applicablt federal, state, and local regulations. Purchase`_ Approval MAR 1 6 2009 BIOHAZAR®OUS WASTE MANIFEST Hazardous Materials Bill of Lading 230905 SPILL EMERGENCIES ONLY: 800- 535 -5053 ei Manifest Number GenVator (Shipper) of Waste: Transporter of Waste: NameC ARMEL CLAY PAM RECRF.ATTON tatewide Medical Services ❑Darob Inc. Addres1 E. 116IH ST. 3601 East 9th Street 1801 Research Drive Indianapolis, IN 46201 Louisville, KY 40269 (317) 634 -0801 (502) 491 -1535 A RAEL Stat U.S. D.O.T. 725204 M 032 -3455 Contact TINA HOVE Account Number 3210 County Telephone (31.7) 573 -5250 UN3291, REGULATED MEDICAL WASTE, n.o.s., 6.2, PG II Customer P/U Hours: Container Size Quantity Rece' ed Weight Monday: 2.2 Cu. Ft. Box 1 Tuesday: Wednesday: Thursday: Friday: Generator (Shipper) Certification: Transporter (Consignee) Certification: This is to certify that the here -in -named materials are properly This is to certify that the here -in -named materials are properly classified, described, packaged, marked, labeled, and are in classified, described, packaged, marked, labeled, and are in proper condition for transportation according to applicable proper condition for transportation according to applicable regulations of the U.S. Depar ent of Transportation. regulations of the U.S. Department of Transportation_ Materials will be destroyed in accordance with all applicable local, state By ate and federal regulations. Signature of authorized representative of waste generator. c� By Date Print Name Tr porter 1 R(M -A Last P /u1 /3 !2008 Print Name No Wei Fri Next Pidco: 212012009 By Date Transporter 2 Print Name B Date T e. Of Lye-�tfitio y Transporter 3 Print Name Liners OH: Designated Facilities: Containers OH: Statewide Medical Services Darob, Inc. 3601 East 9th Street 1801 Research Drive r Arrive Depart: 4 ervice Time: Indianapolis, IN 46201 Louisville, KY 40269 IVVeeKly El (317) 634 -0801 (502) 491 -1535 S.D.O.T. 725204 PAM PFAFFINOER Certificate of Destruction: Certification of receipt a estr do of R materials covered by this manifest number: Signature Dat Original: Statewide Medical Services Copy, Generator A aste rtificate of Destruction to Accompany Invoice STATEWIDE MEDICAL SERVICES INVOICE Full Service Medical Waste Disposal 3601 East Ninth Street Indianapolis, Indiana 46201 -2511 Invoice Date Invoice (3 17) 634 -0801 14 02/26/2009 185749 kA 0 8 2009 Invoice Due: 3/28/2009 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 Account Number: 3210 P.O. Number: Terms: Net 30 Date Description Manifest Department: Qty Lbs Rate Amount 02/20/2009 Regulated Medical Waste 2.25 Cu. Ft. #235006 1 Containers $32.50 $32.50 Box 02/20/2009 Energy Surcharge 235006 1 $4.42 $4.42 Total $36.92 Sales Tax $0.00 Total Invoice Due $36.92 Total past due (See below) $36.92 *Total Current and past due $73.84 Minimum amount due now $36.92 Amount due 3/28/2009 $36.92 Current and outstanding unpaid invoice history: P Mt�11..1 Invoice Date Current 30 -60 60 -90 90+ 183130 12/31/2008 $0.00 $36.92 $0.00 $0.00 P wI` pop 185749 2126/2009 $36.92 $0.00 $0.00 $0.00 0,�� le a JJ 43Y IgSS Totals $36.92 $36.92 $0.00 $0.00 Bud DESTRUCTION CERTIFIED Waste destroyed in accordance with all applicable federal, state, and local regulations. MAR 66 2009 B A BIOHAZAR®OUS WASTE MANIFEST Hazardous Materials Bill of Lading 2 SPILL EMERGENCIES ONLY: 800 -535 -5053 Manifest Number Generator (Shipper) of Waste: Transporter of Waste: C ARXIEL CLAY PARKS RECREATION Na Statewide Medical Services Darob, Inc. Addre§i E. 116Th ST. 3601 East 9th Street 1801 Research Drive Indianapolis, IN 46201 Louisville, KY 40269 (317) 634 -0801 (502) 491 -1535 St U.S.D.O.T. 725204 4 q 32 -3455 Contac 'N HCTZ Account Number 3210 County Telephone (317) 573 -5250 UN3291, REGULATED MEDICAL WASTE, n.o.s., 6.2, PG II Customer P/U Hours: Container Size Quantity Rec d Weight Monday: 2.25 Cu. Rt. Box Tuesday: Wednesday: Thursday: Friday: Generator (Shipper) Certification: Transporter (Consignee) Certification: This is to certify that the here -in -named materials are properly This is to certify that the here -in -named materials are properly classified, described, packaged, marked, labeled, and are in classified, described, packaged, marked, labeled, and are in proper condition for transportation according to applicable proper condition for transportation according to applicable regulati s of the U.S. Department of Transportation. regulations of the U.S. Department of Transportation. Materials will be destroyed in accordance with all applicable local, state Y BY Datz and federal regulations. 6ature of authori presentative of waste generator. B Date y ''l- s Z' Print Name ��)l I A Tr nsporter 1 RouTe -N, -A Last P /M. /26f21008 Print Name �l �-1' NE Week Fri Next Pidw 411'7/2009 o es: By Date Transporter 2 Print Name Ty a Of Destructio By Date Transporter 3 Print Name Liners OH: Designated Facilities: Containers OH: Statewide Medical Services Darob, Inc. 3601 East 9th Street 1801 Research Drive Arrive: Depart: Service Time: Indianapolis, IN 46201 Louisville, KY 40269 u (317) 634 -0801 (502) 491.1535 PfIPPAPirtNG U.S.D.O.T. 725204 Certificate of Destru Po Cer io eipt and destruction of RMW materials covered by this manifest number:y� Signature Date Original: Statewide Medical Services Copy: Generator of Waste Certificate of Destruction to Accompany Invoice F. 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 12/31/08 183130 Regulated Medical Waste 36.92 2126109 185749 Regulated Medical Waste 36.92 Total 73.84 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 361011 Statewide Medical Services 3601 E. 9th St. a Indianapolis, IN 46201 -2511 In Sum of 73.84 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept wn e� 40134.3n IQ� 3C�. Q2 I hcroF�� ceiifii th �4 lha attached inunirakl nr IUI+f 1047 185749 43419q 36.92 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 8 -Apr 2009 Signature 73.84 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund