HomeMy WebLinkAbout220657 06/04/2013 F CITY OF CARMEL, INDIANA VENDOR: 146900 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL M T
4 CARMEL, INDIANA 46032 CASHIER OFFICE-MAIL CODE 50-10C HECK AMOUNT: $60.00
100 N SENATE AVE CHECK NUMBER: 220657
INDIANAPOLIS IN 46204
CHECK DATE: 6/4/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 5129156 30 . 00 OTHER EXPENSES
601 5023990 5129240 30 . 00 OTHER EXPENSES
IDEM Indiana Department of Environmental Management
100 N. Senate Avenue Invoice Number: 5129240
Mail Code 66-34 Renewal Fee: $30.00
Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 16,2013
Certificate Number: DS936716
Expiration Date: 06/30/2013
Grade: DSL
PAUL V. PACE
3450 WEST 131 ST STREET Obtained By: Examination
_
Westfield IN 46074 Login ID: DS936716
0� Password: 581243
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Water Works Operator Certification Renewal Fee Statement
Our records indicate your Water Works Certificate No. DS936716, Grade DSL for a class DSL Water
Distribution System expires on 06/30/2013. You are required to obtain 15.00 contact hours of continuing
education for renewal. Our records indicate that you currently have accumulated 18.00 contact hours
0
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, 2013. After this date you are on expired status and are not
a valid certified operator. You do have until July 1, 2014 to get your continuing education hours and renew
your certification. Failure to renew by July 1, 2014 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 50-1 OC
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: DS936716 Invoice Number: 5129240
PWS Name PWS ID
CARMEL WATER DEPT 5229004
Address Change:
Home Phone Number:
Work Phone Number:
Operator Signature: /�� Date:
(2)
1DEM Indiana Department of Environmental Management
100 N.Senate Avenue Invoice Number: 5129156
1'7 Mail Code 66-34 Renewal Fee: $30.00
Indianapolis,IN 46204-2251
Money Receipt#
(Office Only)
May 16,2013
Certificate Number: DS875167
Expiration Date: 06/30/2013
° Grade: DSL
s DONALD R. SIMPSON Obtained By: Examination
9137 Timpani Way
Indianapolis IN 46231 Login ID: DS875167
.� Password: 580744
s, INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Water Works Operator Certification Renewal Fee Statement
Our records indicate your Water Works Certificate No. DS875167, Grade DSL for a class DSL Water
Distribution System expires on 06/30/2013. You are required to obtain 15.00 contact hours of continuing
education for renewal. Our records indicate that you currently have accumulated 24.00 contact hours
0
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, 2013. After this date you are on expired status and are not
a valid certified operator. You do have until July 1, 2014 to get your continuing education hours and renew
your certification. Failure to renew by July 1, 2014 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 littps://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 50-1 OC
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: DS875167 Invoice Number: 5129156
PWS Name PWS ID
CARMEL WATER DEPT 15229004
Address Change:
Home Phone Number:
Work Phone Number:
Operator Signature: Date:
(2)
VOUCHER # 131664 WARRANT # ALLOWED
146900 IN SUM OF $
IN DEPT. OF ENVIRONMENTAL MGT.
P.O. BOX 7060
INDIANAPOLIS, IN 46207-7060
I
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR 7
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
5129240 01-6040-05 $30.00
Srac)15Le
Voucher Total
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
146900
IN DEPT. OF ENVIRONMENTAL MGT. Purchase Order No.
P.O. BOX 7060 Terms
INDIANAPOLIS, IN 46207-7060 Due Date 5/23/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/23/2013 5129240 $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