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Home My WebLink About220657 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