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Home My WebLink About209578 06/05/2012 CITY OF CARMEL, INDIANA VENDOR: 146900 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL M T CARMEL, INDIANA 46032 CASHIER OFFICE MAIL CODE 50 -10C HECK AMOUNT: $150.00 100 N SENATE AVE CHECK NUMBER: 209578 INDIANAPOLIS IN 46204 CHECK DATE: 6/5/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 4540409 60.00 OTHER EXPENSES 601 5023990 4540412 30.00 OTHER EXPENSES 601 5023990 4540820 30.00 OTHER EXPENSES 601 5023990 4540833 30.00 OTHER EXPENSES l cw m Indiana Department of Environmental Management xa 100 N. Senate Avenue Invoice Number: 4540820 Mail Code 66 -34 Renewal Fee: $30.00 Indianapolis, IN 46204 -2251 Money Receipt (Office Only) May 18, 2012 Certificate Number: WT062975 TIMOTHY L. VANDERGRIFF Expiration Date: 06/30/2012 Tip ton IN 46072 East 300 South Grade: WT3 963 Obtained By: Examination Tip Login ID: WT062975 Password: 582720 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works Operator Certification. Renewal Fee Statement Our records indicate your Water Works Certificate No. WT062975, Grade WT3 for a class WT3 Water Treatment Plant expires on 06/30/2012. You are required to obtain 25.00 contact hours of continuing education for renewal. Our records indicate that you currently have accumulated 25.00 contact hours towards renewal. (This may not reflect hours for courses recently attended.) Note: If you have not recently attended an approved course, and you do not have the required number of hours, you need to attend courses prior to July 1, 2012. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2013 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2013 will result in termination of your certification, and you will have to retest. Online Renewal Online renewal is available 24 hours a day, 7 days a week at https: /mylicense.in. -ov The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal. The forms of payment accepted online are Visa, Master Card, Discover credit and debit cards. Login ID and Password are listed above. Mail Renewal To renew through the iiiail, please fill out the section on the back of this page and return this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take longer than an online renewal. If you have other drinking water certifications due renewal, you can combine them in one mailing with a fee payment that covers all of them. For example: (3 renewals x $30 /per renewal) $90 combined fee. Remit Payment to: Indiana Department of Environmental Management Cashier's Office Mail Code 50 -1OC 100 N. Senate Avenue Indianapolis, IN 46204 -2251 SEE FORM ON OTHER SIDE Cancel Certification If you do not want to renew this certification, please write "CANCEL" on this form, sign and date in spaces provided, and mail to the remittance address listed. FILL OUT RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING If this certification was obtained by Examination and the facility you are employed at has changed, please add your new employer in the space provided. NOTE If this certification is Grandfathered or Site Specific, it is valid only for the location below. Operator Number: WT062975 Invoice Number: 4540820 PWS Name PWS ID Carmel Water Department 15229004 Address Change: Home Phone Number: Work Phone Number: Operator Signature* Date: IDEM Indiana Department of Environmental Management x 100 N. Senate Avenue Invoice Number: 4540833 Y Mail Code 66 -34 Renewal Fee: $30.00 Indianapolis, IN 46204 -2251 Money Receipt (Office Only) May 18, 2012 Certificate Number: WT062539 WILLIAM A. BELL JR Expiration Date: 06/30/2012 Grade: WT3 5419 South 225 West Obtained By: Examination Atlanta IN 46031 Login ID: WT062539 Password: 582707 INDIANA DEPARTMENT OF ENVIRONMENT MANAGEMENT Water Works Operator Cert &gtion Renewal Fee Statement Our records indicate your Water Works Certificate No. WTQ62539, Grade WT3 for a class WT3 Water Treatment Plant expires on 06/30/2012. You are required to obtain 25.00 contact hours of continuing education for renewal. Our records indicate that you currently have accumulated 29.00 contact hours towards renewal. (This may not reflect hours for courses recently attended.) Note: If you have not recently attended an approved course, and you do not have the required number of hours, you need to attend courses prior to July 1, 2012. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2013 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2013 will resplt in termination of your certification, and you will have to retest. Online Renewal Online renewal is available 24 bgyrs day, 7 days a week at https: /mylicense.in.gov The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal. The forms of payment accepted online are Visa, Master G"atd, Discover credit and debit cards. Login ID and Password are listed above. Mail Renewal To renew through the mail, please filj oqt the section on the back of this page and return this entire letter with $30 fee payment to the remittggf -p address listed. Be sure to sign and date in spaces provided. Make a photocopy for your records. Plse note that renewal through the mail will take longer than an online renewal. If you have other drinking water certifications due rel}ew4j, you can combine them in one mailing with a fee payment that covers all of them. For example; (3 repewals x $30 /per renewal) $90 combined fee. Remit Payment to: Indiana Department of Environrpeilt�l Management Cashier's Office Mail Code 50 10P 100 N. Senate Avenue Indianapolis, IN 46204 -2251 SEE FORM ON OTIIER SIDE Cancel Certification If you do not want to renew this certification, please write "CANCEL" on this form, sign and date in spaces provided, and mail to the remittance address listed. FILL OUT RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING If this certification was obtained by Examination and the facility you are employed at has changed, please add your new employer in the space provided. NOTE If this certification is Grandfathered or Site Specific, it is valid only for the location below. Operator Number: WT062539 Invoice Number: 4540833 PWS Name PWS ID Carmel Water Department 15229004 Address Change: Home Phone Number: '13 `81 Work Phone Number: 30 95 Operator Signature: C�r��"`J�`�' Date: S .001 Indiana Department of Environmental Management 100 N. Senate Avenue Invoice Number: 4540407 Mail Code 66 -34 Renewal Fee: $30.00 Indianapolis, IN 46204 -2251 Money Receipt (Office Only) May 18, 2012 Certificate Number: DS063072 Expiration Date: 06/30/2012 MICHAEL E. LUPER II Grade: DSL Westfield IN 46600 74 131st Obtained By: Examination West Login ID: DS063072 Password: 582715 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. DS063072, Grade DSL for a class DSL Water Distribution System expires on 06/30/2012. You are required to obtain 15.00 contact hours of continuing education for renewal. Our records indicate that you currently have accumulated 27.50 contact hours towards renewal. (This may not reflect hours for courses recently attended.) Note: If you have not recently attended an approved course, and you do not have the required number of hours, you need to attend courses prior to July 1, 2012. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2013 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2013 will result in termination of your certification, and you will have to retest. Online Renewal Online renewal is available 24 hours a day, 7 days a week at https: /mylicense.in.gov The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal. The forms of payment accepted online are Visa, Master Card, Discover credit and debit cards. Login ID and Password are listed above. Mail Renewal To renew through the mail, please fill out the section on the back of this page and return this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take longer than an online renewal. If you have other drinking water certifications due renewal, you can combine them in one mailing with a fee payment that covers all of them. For example: (3 renewals x $30 /per renewal) $90 combined fee. Remit Payment to: Indiana Department of Environmental Management Cashier's Office Mail Code 50- IOC 100 N. Senate Avenue Indianapolis, IN 46204 -2251 SEE FORM ON OTHER SIDE Cancel Certification If you do not want to renew this certification, please write "CANCEL" on this form, sign and date in spaces provided, and mail to the remittance address listed. FILL OUT RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING If this certification was obtained by Examination and the facility you are employed at has changed, please add your new employer in the space provided. NOTE If this certification is Grandfathered or Site Specific, it is valid only for the location below. Operator Number: DS063072 Invoice Number: 4540407 PWS Name PWS ID Carmel Water Department 5229004 Address Change: Home Phone Number: Work Phone Number: �3/'> 733 -.?fs' Operator Signature: Date: S -1 412 s Q Indiana Deparunent of Environmental Management p 100 N. Senate Avenue Invoice Number: 4540412 Mail Code 66 -34 Renewal Fee: $30.00 Indianapolis, IN 46204 -2251 Money Receipt (Office Only) May 18, 2012 Certificate Number: DS063092 SEAN W. WHITLOW Expiration Date: 06/30/2012 3450 W. 131 st St. Grade: DSL Westfield IN 46074 Obtained By: Examination Login ID: DS063092 Password: 579828 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. DS063092, Grade DSL for a class DSL Water Distribution System expires on 06/30/2012. You are required to obtain 15.00 contact hours of continuing education for renewal. Our records indicate that you currently have accumulated 15.00 contact hours towards renewal. (This may not reflect hours for courses recently attended.) Note: If you have not recently attended an approved course, and you do not have the required number of hours, you need to attend courses prior to July 1, 2012. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2013 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2013 will result in termination of your certification, and you will have to retest. Online Renewal Online renewal is available 24 hours a day, 7 days a week at https:Hmylicense.in.gov The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal. The forms of payment accepted online are Visa, Master Card, Discover credit and debit cards. Login ID and Password are listed above. Mail Renewal To renew through the mail, please fill out the section on the back of this page and return this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take longer than an online renewal. If you have other drinking water certifications due renewal, you can combine them in one mailing with a fee payment that covers all of them. For example: (3 renewals x $30 /per renewal) $90 combined fee. Remit Payment to: Indiana Department of Environmental Management Cashier's Office Mail Code 50 -1OC 100 N. Senate Avenue Indianapolis, IN 46204 -2251 SEE FORM ON OTHER SIDE Cancel Certification If you do not want to renew this certification, please write "CANCEL" on this form, sign and date in spaces provided, and mail to the remittance address listed. FILL OUT RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING If this certification was obtained by Examination and the facility you are employed at has changed, please add your new employer in the space provided. NOTE If this certification is Grandfathered or Site Specific, it is valid only for the location below. Operator Number: DS063092 Invoice Number: 4540412 PWS Name PWS ID Carmel Water Department 15229004 Address Change: I� 0 W c &074 Home Phone Number: J J l J I 7 Work Phone Number: umber: 317 W/ 5 Operator Signature: Date: 1 °E, Indiana Department of Environmental Management 100 N. Senate Avenue Invoice Number: 4540409 Mail Code 66 -34 Renewal Fee: $30.00 Indianapolis, IN 46204 -2251 Money Receipt (Office Only) May 18, 2012 Certificate Number: DS063078 JERRY G. SMITH IV Expiration Date: 06/30/2012 3450 WEST 131 ST STREET Grade: DSL Westfield IN 46074 Obtained By: Examination Login ID: DS063078 Password: 582706 rn l� INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Water Works Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. DS063078, Grade DSL for a class DSL Water Distribution System expires on 06/30/2012. You are required to obtain 15.00 contact hours of continuing education for renewal. Our records indicate that you currently have accumulated 36.50 contact hours towards renewal. (This may not reflect hours for courses recently attended.) Note: If you have not recently attended an approved course, and you do not have the required number of hours, you need to attend courses prior to July 1, 2012. After this date you are on expired status and are not a valid certified operator. You do have until July 1, 2013 to get your continuing education hours and renew your certification. Failure to renew by July 1, 2013 will result in termination of your certification, and you will have to retest. Online Renewal Online renewal is available 24 hours a day, 7 days a week at https: /mylicense.in.2ov The cost for the online renewal is $30.00 plus an additional processing fee for each certification renewal. The forms of payment accepted online are Visa, Master Card, Discover credit and debit cards. Login ID and Password are listed above. Mail Renewal To renew through the mail, please fill out the section on the back of this page and return this entire letter with $30 fee payment to the remittance address listed. Be sure to sign and date in spaces provided. Make a photocopy for your records. Please note that renewal through the mail will take longer than an online renewal. If you have other drinking water certifications due renewal, you can combine them in one mailing with a fee payment that covers all of them. For example: (3 renewals x $30 /per renewal) $90 combined fee. Remit Payment to: Indiana Department of Environmental Management Cashier's Office Mail Code 50 -IOC 100 N. Senate Avenue Indianapolis, IN 46204 -2251 SEE FORM ON OTHER SIDE Cancel Certification If you do not want to renew this certification, please write "CANCEL" on this form, sign and date in spaces provided, and mail to the remittance address listed. FILL OUT RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING If this certification was obtained by Examination and the facility you are employed at has changed, please add your new employer in the space provided. NOTE If this certification is Grandfathered or Site Specific, it is valid only for the location below. Operator Number: DS063078 Invoice Number: 4540409 PWS Name PWS ID Carmel Water Dep artment 1 5 229004 Address Change: 3 4 Y 5 0 1 Sfi S /A/, Home Phone Number: 3 1 7- 5 V-11 3 Work Phone Number: 3 3 c� SS Operator Signature: Date: 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 146900 IN DEPT. OF ENVIRONMENTAL MGT. Purchase Order No. P.O. BOX 7060 Terms INDIANAPOLIS, IN 46207 -7060 Due Date 5/30/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/30/2012 4540820 $30.00 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 Date Officer VOUCHER 121072 WARRANT ALLOWED 146900 IN SUM OF IN DEPT. OF ENVIRONMENTAL MGT. I o C Car LY1t�eo� y 51 ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 4540820 01- 6040 -03 $30.00 y 514 0B3 1 4 30,0 y 514 oU00f of %00110 -0S 45uoUt�L ot.t0040-K 30.E y5Lio40 of (0040 Uq 30•x' Voucher Total Cost distribution ledger classification if claim paid under vehicle highway fund