211440 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 358593 Page 1 of 1
ONE CIVIC SQUARE REPUBLIC WASTE SERVICES OF INDIA CHECK AMOUNT: $3,369.30
CARMEL, INDIANA 46032 PO BOX 9001099
LOUISVILLE KY 40290-1099 CHECK NUMBER: 211440
CHECK DATE: 7131/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 07610012460 3 , 369 . 30 OTHER EXPENSES
�R
W REPUBLIC CARMEL UTILITIES HHW Invoice
SERVICES Page 1 of 3
832 Langsdale Ave
Indianapolis,IN 46202-1150
Payments/Adjustments
Date Description Reference Amount
06109 Payment-Thank You 209322 -$3,369.30
06/25 Payment-Thank You 210113 -$3,216.15
Account Number 3-0761-1163292
Invoice Date June 30,2012 Current Invoice Charges
Invoice Number 0761-001246058 Carmel Utilities Hhw 901 N Range Line Rd (1_1) CSA 32921 21 01 0
Previous Balance $6,585.45 Carmel,IN
Payments/Adjustments -$6,585.45
Unpaid Balance $0.00 1 -Hooklift(30 Yd) Scheduled Service (S1) Comingled
Current Invoice Charges $3,369.30 Date Description Reference Quantity Unit Price Amount
06/01 Basic Service 1.0000 $153.15 $153.15
Receipt Number 63312
06/04 Basic Service 1.0000 $153.15 $153.15
Receipt Number 64214
06/06 Basic Service 1.0000 $153.15 $153.15
$3,369.30 Receipt Number 65213
06/08 Basic Service 1.0000 $153.15 $153.15
Due By: 07/20/12 Receipt Number 65256
06/11 Basic Service 1.0000 $153.15 $153.15
Receipt Number 67952
06/15 Basic Service 1.0000 $153.15 $153.15
Customer Service (317)917-7300 Receipt Number 70480
06/18 Basic Service 1.0000 $153.15 $153.15
Receipt Number 71500
06/25 Basic Service 1.0000 $153.15 $153.15
Receipt Number 75346
02011M 0 0 06/27 Basic Service 1.0000 $153.15 $153.15
Effective 4/16/2012:SERVICE INTERRUPTION Receipt Number 77111
POLICY CHANGE All accounts with a balance over
60 days will experience a service interruption unless 1 -Rolloff(30 Yd) Scheduled Service (S3) Comingled
prior arrangements are made.
Date Description Reference Quantity Unit Price Amount
06/01 Basic Service 1.0000 $153.15 $153.15
Receipt Number 37829
06/04 Basic Service 1.0000 $153.15 $153.15
Receipt Number 37829
06/06 Basic Service 1.0000 $153.15 $153.15
- CURRENT. ,,_ 30 DAYS - 60 DAYS 90+"DAYS:
3,369.30 0.00 0.00 0.00
To pay on-line or sign up for
convenient auto pay, go to: DA • Visit our website,www.disposal.com to make your payment electronically
www.disposal.com or to sign up for our convenient automatic payment plan.
i Please see reverse side for terms and conditions
CARMEL UTILITIES HHW 3-0761-1163292 Page 2 of 3
Check Processing: In accordance with Federal Reserve Board guidelines, when you provide a check as payment, you
authorize us to use information from your check to make a one-time electronic fund transfer from your account or to
process the payment as a check transaction. When we use information from your check to make an electronic fund
transfer, funds may be withdrawn from your account as soon as the same day we receive your payment and you will not
receive your check back from your financial institution. For further information visit: www.electronicpayments.org and click
on the Check Conversion tab.
If service is canceled during a billing cycle, the customer will remain responsible for all charges, fees and taxes through the
end of the billing cycle. There will be no proration of billing, and the customer will not be entitled to a refund for the period
between the notice of termination and the end of the current billing cycle. This provision will not apply if it is contrary to a
current franchise agreement, municipal contract, or other written contract applicable to this account or is otherwise
prohibited by law.
The Company reserves the right to require that payment for services be made only by check, credit card or money order,
unless otherwise required by contract or applicable law.
001528-000002-000002-003056 2305528 2240ST03 1 3
Page 3 of 3
R CARMEL UTILITIES HHW Republic Services #761
Account Number 3-0761-1163292
g tW REPUBLIC Invoice Date June 30, 2012 832 Langsdale Ave
+!►2ti SERVICES Invoice Number 0761-001246058 Indianapolis, IN 46202-1150
Current Invoice Charges
Date Description Reference Quantity Unit Price Amount
Receipt Number 37829
06/08 Basic Service 1.0000 $153.15 $153.15
Receipt Number 37829
06/11 Basic Service 1.0000 $153.15 $153.15
Receipt Number 37829
06/13 Basic Service 1.0000 $153.15 $153.15
Receipt Number 37829
06/15 Basic Service 1.0000 $153.15 $153.15
Receipt Number 37829
06/18 Basic Service 1.0000 $153.15 $153.15
Receipt Number 37829
06/20 Basic Service 1.0000 $153.15 $153.15
Receipt Number 37829
06/22 Basic Service 1.0000 $153.15 $153.15
Receipt Number 37829
06/25 Basic Service 1.0000 $153.15 $153.15
Receipt Number 37829
06/27 Basic Service 1.0000 $153.15 $153.15
Receipt Number 37829
06/29 Basic Service 1.0000 $153.15 $153.15
Receipt Number 37829
Current Invoice Charges $3,369.30
VOUCHER # 125349 WARRANT # ALLOWED
358593 IN SUM OF $
REPUBLIC WASTE SERVICES OF INDI
PO BOX 9001099
LOUISVILLE, KY 40290-1099
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
07610012460 01-736H-08 $3,369.30
Voucher Total $3,369.30
Cost distribution ledger classification if
claim paid under vehicle highway fund
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
358593
REPUBLIC WASTE SERVICES OF INDIANA Purchase Order No.
PO BOX 9001099 Terms
LOUISVILLE, KY 40290-1099 Due Date 7/20/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/20/2012 0761001246( $3,369.30
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
-orrect and I have audited same in accordance with IC 55-11-10-1.6
Date Officer