HomeMy WebLinkAbout209578 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 >ion 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