The URL can be used to link to this page

221565 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 146900 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL M T ECK AMOUNT: $60.00 H CARMEL, INDIANA 46032 CASHIER OFFICE-MAIL CODE 50-10C 100 N SENATE AVE CHECK NUMBER: 221565 INDIANAPOLIS IN 46204 CHECK DATE: 7/2/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 5129202 30 . 00 OTHER EXPENSES 601 5023990 5130554 30 . 00 OTHER EXPENSES 1DENI Indiana Department of Environmental Management 100 N.Senate Avenue Invoice Number: 5129202 Mail Code 66-34 Renewal Fee: $30.00 Indianapolis,IN 46204-2251 Money Receipt# (Office Only) May 16,2013 >R Certificate Number: D9916079 Expiration Date: 06130/2013 Grade: DSL JOHN A.MASCARI Obtained By: Examination a 6220 East 55th Place - Indianapolis IN 46226 Login ID: WT998236 Password: 581954 MA INDIANA DEPARTMENT.OF:ENV IRON MENTAL MANAGEMENT Water Works Operator Certification - - - -�-� �rtif ication Renewal Fee Statement Our records indicate your Water Works Certificate No. DS916079, Grade DSL for a class DSL Water Distribution System expires on 06/30/2013. You are required to obtain 15.00 contact hours of coritilriung; s education for renewal. Our records indicate that you currently have accumulated 63.00 contact-.ho , ?'> ,$ towards renewal. (This may not reflect hours for courses recently attended.) , o , t w 4{g Note: If you have not recently attended an approved course, and you do not have the;irequred';number hours, you need to attend courses prior to July 1, 2013. After this date you are;.onY expiredilstatusg andfare notY;x `f 3.fax I'.. "'.6 f tlg 1� ,�ad e aY�`M'Vk�•`''h,y,t .J y . a valid certified operator. You do have until July 1, 2014 to get your cunt uing.eclUAion hurs:and,reTnew,, ;i ,F _Qy�!i' your certification. Failure to renew by July 1, 2014 will result in terrnination,,of�yourytcertif cation andpyou "r w F,"oyp'•(tr: N..;Y^/� d M`�will have'to retest. �r ula �r {ice �c f a r{yy9 :Renewal—Online renewal is,-.available 24 hours a day, T days a week athp /�/m1 yr l Online tcense X 7 t �ta The cost for the online renewal is $30.00 plus an addi,tional:processiing.fee foreeach,,certt icat onare`newal 4 .f= {' The forms of payment accepted online are Visa, Master Card', & Discov,p' credit and4+debrt caids'`'�lo in`hD� ;' and Password re listed g o a sted above. --_,..-_. — - m•i1 n't_-to . r_ 4`j Y r�l1�`.Dt.Ce-41 13R 1];(. ,s» i,r :v.,'-.lUe, ,• 'i t�x�d`, NIV Mail Renewal—To renew thr o ugH th e'ma11, p le 13&W Oht iid i,pv`+"a<-�`•w g fethis entire letter with $30 e nav 11 "'ne�r.k�,a4rta�n��2:da:��'�,/�r b d eyr"'tna�Su' r'er!.`+ln ar7r k�M$'`r w�s"i v�.V�q,�R t i'''P.5„°•; :z�CTC7C�"1TT n,$dgJ 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 50-10C 100 N. Senate Avenue Indianapolis, IN 46204-2251 SEE FORM ON OTHER SIDE Cancel Certification - If you do not want to renew this certification lease write CANCEL on Y , p 5 61 form, sign and date in spaces provided, and mail to the remittance address listed. • r"."yrtr�.. FILL OUT & RETURN ENTIRE LETTER WHEN RENEWING BY MAIL OR CANCELLING > ;E :a 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: DS916079 Invoice Number: 5129202 PWS Name PWS ID r ; i> yl Carmel Water._D_e artment 5229004 Address Change: ? f� Home Phone Number: Work Phone Number: ( -7 33 - 21�s!5- Operator Signature: Date: ,:rc{nh'wir tsar;! r ♦ i' "j r,M 31 y 1¢ � .} � r F 'Jy .� ,w 'N '� f ✓n �i fi x IS: Jv1i� t ., ��Cd�D�4 } ',r+`1 C�"n' a +y,. ,{�/ ��4 •& it e'-�ih,s�� `ab Nei i r. dza a-, ., t ''Ud t: +pt ,flp�� rb`r 4 4 Y I 1 c10,_} 3Lt Y �A JSY Sif•4"�,-- �'�V 't kr?H1rro�aJ Y. Tab pit r� 'i'l��+a�. :1 } (2) 'i 113EM ;Indiana Department of Environmental Management '160'N.Senate Avenue Invoice Number: 5130554 Mail Code 66734 Renewal Fee: $30.00 Indianapolis;IN 46204-2251 .,Money Receipt# .Office': May 16,2013 Certificate Number: WT998236 Expiration Date: 06/30/2013 Grade: WT3 JOHN!A.MASCARI 16220';East,55th Place Obtained By: Examination Ipdianapol'is''IN,46226 Login ID: WT998236 Password: 581954 1 _ IND:IA'NA DEPAR`.I MENT•OF`'E, I'R;ONM'E'NTAL MANAGEMENT ;Srf. .. .. ,...�,• . :,'r_`.i:"�4v5i^ ."0.d!'e:>'vi.r L-�.:.,i e''7�'' ,� ....:... .1...._.��.. ..- _...- -. .-...WO Water - r�s Operator Certification Renewal Fee Statement Our records indicate your Water Works Certificate No. WT998236, Grade WT3 for a class WT3 Water Treatment Plant expires on 06/30/2013. You are required to obtain 25.00 contact hours of continuing education for renewal. Our records indicate that you currently have accumulated 63.00 contact hours towards renewal. (This may not reflect hours for courses recently attended.) 'f`f`� „ ..,,i^� ,, ...,,: •;'°;,iun';i'^'f;igStl.'rk�n"�;td.�iiyr`�t`^ir;* Note: If you have not recently attended an approved course, and you do not have the:fequiredf,riu b';§rj04 1 > •'! e )r- n lat d raa';Gid0�;4�sr 'r" .�§T�i$. hours you need to attend courses prior to July 1 2013. After this date you are on ex ired(s:tatus,andiareknot� a valid certified operator. You do have until July 1, 2014 to get your cont'inu'ing e'd wi,,t p i catigi �Hours;andirenew your certification. Failure to renew by July 1, 2014 will result in termination of your certification',' and�youk will have to retest. ":k"Nr, ;i,�;K.r,�;t,d,;�, .;yc.{ry,J;:y Y,`�,s�y;'''fi�'�r�'r�.�n��3:^• Online Renewal- Online renewal is available 24 hours a day, 7 days'a week av-*,Jifi s 4,1'/mylic nsem The cost for the online renewal is $30.00 plus an additional processing fee'forteaclifYcerti-icationµrrenewa�l� G, Wi�Jtir �y W„ A The fors of payment accepted online are Visa, Master,164dr& D>ascouer�credltti;andudeb>t cardst± L m ozgm ISD '� , ,� l a'� s rfi{r`d and Password are listed above. + 3R wxp � y�, Y e r �� kw 4t v it V J ipt� ri H fi Jt� 1 +a• ,. r, y, k7Sr ldr� 1, Jif � .J.a' , !y, �i ! �i, „ p'twW:�a �,�, '�'T�',�'y c a� •,� 3E � Mail Renewal-To.:renew through the�n'iail, pleaserfil outzthe section on�the back of this page and,returna ,.;`�T, �^ this entire letter with 0 fe._emjment_to-.th.e.ce nittanee-addtas'..Iisted.-B'ecur ''to stgi' "attr iir=- 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 x. 100 N. Senate Avenue >;r Indianapolis, IN 46204-2251 SEE FORM ON OTHER SIDE (1) 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: WT998236 Invoice Number: 5130554 PWS Name PWS ID - Carmel Water Department 5229004 Address Change: Home Phone Number17) 3 00 Work Phone Number: 7� X33 r 28 SS Operator Signature: Date: i (2) 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 6/26/2013 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 6/26/2013 5129202 $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 VOUCHER # 131933 WARRANT # ALLOWED 146900 IN SUM OF $ IN DEPT. OF ENVIRONMENTAL MGT. P.O. BOX 7060 INDIANAPOLIS, IN 46207-7060 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 5129202 01-6040-03 $30.00 5i 30 55if ►r 3Z•C0 I Voucher Total G O hh ' 0 Cost distribution ledger classification if claim paid under vehicle highway fund