HomeMy WebLinkAbout216081 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1
0 ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURTIHECK AMOUNT: $360.00
CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY-FISCAL OFFI
', ua 302 W WASHINGTON ST,RM E221 CHECK NUMBER: 216081
INDIANAPOLIS IN 46204
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4358300 734241112920 240 . 00 OTHER FEES & LICENSES
1091 4358300 734241122720 120 . 00 OTHER FEES & LICENSES
I
ELEVATOR OPERATING CERTIFICATE INVOICE
ARMEL/CLAY BOARD OF PARKS & RECREATION 1411 E 116TH ST Pat Schlemmer CARMEL IN 46032
l.If Code = * An annual test report is due before a permit is issued.
2.If Code = # A 5 year Test report is due before a ermit is issued.
3.Over due fees must be paid before as permit is issued.
If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE
AFFIRMATION" form.
State No.Code Due Over Due Location Address
111704 * $120.00 $ 0.00 1235 CENTAL PARK DR EAST, CARMEL IN 46032
111978 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 46032
.A13 **Wsp1 1
purchase C�
G=,scription P or F
P.O.#
e.�.# � �—' LN V 30 2012
i
i3i;rJGPt L.Ii1P Des cr Date -
,urchaser
I
I
Reference Number Invoice Date Please submit ENTIRE document with payment
734241-11292012 -1 11/29/2012 Unit(s) 2 Total Due upon receipt
of 2 $ 240.00 of $ 240.00
Owner Id 734241
Ref.Num. :734241-11292012 - 1 $240 of $ 240.00 Invoice Date 11/29/2012
I
If Paying by check, include a check made payable to the Department of Homeland security. You can pay all your
payments online at IDHS web site https://myoracle.in.gov/dfbs/idhsFeesFines/start.do with Visa/Master
Card/Discover cards. Use Owner Id on this letter or State Number on the invoice to pull up information when
paying the dues online.OR complete the following information and return by mail :Indiana Department of
Homeland Security, Fiscal Department, 302 W.Washington St., Rm : E221,Indianapolis, IN 46204 or fax to
(317)233-0401. Questions? call(317)232-6427 or E-mail:elevator-invoice@dhs.in.gov 2.25% convenience fee
charged on all credit card payments.
Full Name on Credit Card
Billing Address: Street
City State Zip Code
CC type:Am.Express/Discover/Master Card ONLY (circle one) (VISA payment online only)
Acct. Number Exp.Date (mm/yy)
CVV2 Number Contact Phone Number Signature
By signing, cardmember agrees to the obligations set forth by the Cardmember's
Agreement with the issuer.
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GLGVt11 VSl VC GSlA11lYV VG[\L 1L-1L.A1G VV1l.G
CARMEL/CLAY BOARD OF PARKS & RECREATION 1411 E 116TH ST Pat Schlemmer CARMEL IN 46032
l.If Code = * An annual test report is due before aermit is issued.
2.If Code = # A 5 year Test report is due before a-permit is issued.
3.0ver due fees must be paid before a_permit is issued.
If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE
AFFIRMATION" form.
State No.Code Due Over Due Location Address
111703 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 40632
Purchase
o2u 13
Description finnU&�-
P.O.# PorF
G.L.# lll- 43`Jc�3�
Budget
Line escr
Purchaser Date
Approval 4:1 Date / z !3
Reference Number Invoice Date Please submit ENTIRE document with payment
734241-12272012 -1 12/27/2012 Unit(s) 1 Total Due upon receipt
of 1 $ 120.00 of $ 120.00
Owner Id 734241
Ref.Num. :734241-12272012 - 1 $120 of $ 120.00 Invoice Date 12/27/2012
If Paying by check, include a check made payable to the Department of Homeland security. You can pay all your
payments online at IDHS web site https://myoracle.in.gov/dfbs/idhsFeesFines/start.do with Visa/Master
-card/Discover cards. Use Owner Id on this letter or State Number on the invoice to pull up information when
paying the dues online.OR complete the following information and return by mail :Indiana Department of
Homeland Security, Fiscal Department, 302 W.Washington St., Rm : E221,Indianapolis, IN 46204 or fax to
(317)233-0401. Questions? call(317)232-6427 or E-mail:elevator-invoice@dhs.in.gov 2.25% convenience fee
charged on all credit card payments.
Full Name on Credit Card
Billing Address: Street
City State Zip Code
CC type:Am.Express/Discover/Master Card ONLY (circle one) (VISA payment online only)
Acct. Number Exp.Date (mm/yy)
CVV2 Number Contact Phone Number Signature
By signing, cardmember agrees to the obligations set forth by the Cardmember's
Agreement with the issuer.
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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.
229400 Indiana Department of Homeland Security Terms
Fiscal Department
302 W Washington St., Rm E221
Indianapolis, IN 46204
Invoice . Invoice, Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
12/27/12 734241122720121 Annual elevator permit 111703 $ 120.00
11/29/12 734241112920121 Annual elevator permit 111704/111978 $ 240.00
Total $ 360.00
1 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.
229400 Indiana Department of Homeland Security Allowed 20
Fiscal Department
302 W Washington St., Rm E221
Indianapolis, IN 46204 In Sum of$
$ 360.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1091 734241122720121 4358300 $ 120.00 1 hereby certify that the attached invoice(s), or
1091 734241112920121 4358300 $ 240.00 bill(s) is (are)true and correct and that the
materials or services itemized thereon for
i which charge is made were ordered and
received except
3-Jan 2013
Signature
$ 360.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund