211374 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 366244 Page 1 of 1
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ONE CIVIC SQUARE MEDASSURE CHECK AMOUNT: $150.00
CARMEL, INDIANA 46032 1013 S GIRLS SCHOOL ROAD
INDIANAPOLIS IN 46231 CHECK NUMBER: 211374
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 2733 150 . 00 CONT SVS-HAZ WASTE
Invoice
MED SSURE Date Invoice#
A SAFE ANC CLEAN SOLUTIUN'OR YOUR MEIMCAL:4AtiT£STAFA4
7/17/2012 2733
1013 S. Girls School Rd.
Indianapolis, IN 46231
Bill To
Carmel Household Hazardous Waste
901 North Range Line Rd.
Carmel, IN 46032
P.O. Number Terms Via F.O.B. Project
Net 15
Quantity Item Code Description Price Each Amount
3 Box Medical waste removal of cardboard box containers. 25.00 75.00
7/6/12
3 Minimum Charge Minimum pick up. (6)7/6/12 25.00 75.00
Total $150.00
Please remit to:
MedAssure of Indiana
1013 S. Girls School Rd.
Indianapolis, IN 46231
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
366244
MEDASSURE Purchase Order No.
1013 S GIRLS SCHOOL ROAD Terms
INDIANAPOLIS, IN 46231 Due Date 7/24/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/24/2012 2733 $150.00
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 # 125405 WARRANT # ALLOWED
366244 IN SUM OF $
MEDASSURE
1013 S GIRLS SCHOOL ROAD
INDIANAPOLIS, IN 46231
Carmel Wastewater Utility ,
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
2733 01-736H-08 $150.00
Voucher Total $150.00
Cost distribution ledger classification if
claim paid under vehicle highway fund