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222038 07/17/2013 CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURITY CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY-FISCAL OFFI HECK AMOUNT: $150.00 ?y_oN io 302 W WASHINGTON ST,RM E221 CHECK NUMBER: 222038 INDIANAPOLIS IN 46204 CHECK DATE: 7/17/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1093 4350100 304625 25 . 00 BUILDING REPAIRS & MA 1093 4350100 304626 25 . 00 BUILDING REPAIRS & MA 1093 4350100 304627 25 . 00 BUILDING REPAIRS & MA 1093 4350100 304628 25 . 00 BUILDING REPAIRS & MA 1093 4350100 304629 25 . 00 BUILDING REPAIRS & MA 1093 4350100 304631 25 . 00 BUILDING REPAIRS & MA INVOICE FOR INSPECTION / CERTIFICATE FEES o" ie State Form 356(R4/9-93) Approved by the State Board of Accounts-1991 Division of Fire and Building Safety 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online at IDHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY httpsJ/myoracle.in.gov/dfbstidhsFeesFines/start.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone:(317)232-1921 INDIANA STATE----!- NUMBER CARMEL CLAY PARKS & RECREATION LATEST PLEASE INVOICE PAY THIS 304631 ATTN DAWN KOEPPER DATE AMOUNT Owner Id 1411 E 116TH ST 759531 CARMEL, IN 46032-3455 06/18/2013 c\� Owner number User Name&Location of vessel THE MONON CTR Fee 1235 CENTRAL PARK DR E j $ 25.00 CARMEL IN 46032 Serial number -Manufacturer e r W -s Boileres sel —-- - AOSMITH - ---- OD/22/2013e - _ I inspected � National Board No. Inspection agency Name of inspector (This fee is C12490 TRAVELERS CALHOUN JOSEPH S prescribed by ------ ------ - 675 AC 12-3-13)--- -- Inspection Date Inspector Name Inspection Type Due 05/22/2013 CALHOUN JOSEPH S RE-INSPECTION--304631,06/18/2013 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT -- - - Tear here and retain to - ---- p portion for your records -- ------- ---- X447 INVOICE FOR INSPECTION / CERTIFICATE FEES Te State Form 356(R4/9-93) Approved by the State Board of Accounts-1991 �`. Division of Fire and Building Safety &E6 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online at IDHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbs/idhsFeesFines/start.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone:(317)232-1921 INDIANA STATE - - — - - NUMBER LATEST PLEASE i CARMEL CLAY PARKS & RECREATION i I INVOICE PAY THIS 304629 ATTN DAWN KOEPPER � i DATE AMOUNT! I Owner Id 1411 E 116TH ST --- CARMEL, IN 46032-3455 06/18/2013 759531 �I � Owner number User Name&Location of vessel Fee � THE MONON CTR 1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel Manufacturer I Date Last Inspected W T Blr - Hot Water Heating LOCHINVAR ! 05/22/2013 i National Board No- I Inspection agency Name of inspector (This fee is TRAVELERS CALHOUN JOSEPH S I prescribed by - _ ' 675 IAC 12-3-13) -- _ — Inspection Date Inspector Name Inspection Type Due 05/22/2013 CALHOUN JOSEPH S RE-INSPECTION--304629,06/18/2013 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT - - - -- — - - - -- Tear here and retain top portion for your records -------- " rqm INVOICE FOR INSPECTION / CERTIFICATE FEES ux�G se State Form 356(R4/9-93) j� Approved by the State Board of Accounts-1991 Division of Fire and Building Safety 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online at IDHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbs/idhsFeesF!nes/start.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone:(317)232-1921 INDIANA STATE � NUMBER LATEST PLEA SE -- CARMEL CLAY PARKS & RECREATION PLEA 304628 ATTN DAWN KOEPPER INVOICE DATE AMOUN AMOUNS i I i T! Owner Id 1411 E 116TH ST 759531 CARMEL, IN 46032-3455 06/18/2013 J j Owner number User Name&Location of vessel THE MONON CTR Fee 1235 CENTRAL PARK DR E I- --- - i CARMEL IN 46032 $ 25.00 P Serial number Description of vessel P Manufacturer Date Last Inspected W T Boiler LOCHINVAR 05/22/2013 National Board No I Inspection agency Name of ins ector p (This fee is 181629 TRAVELERS CALHOUN JOSEPH S prescribed by - - - - -- i 675 IAC 12-3-13) J Inspection Date Inspector Name Inspection Type Due 05/22/2013 CALHOUN JOSEPH S RE-INSPECTION--304628,06/18/2013 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT ----------- -- -- --- --- - ear here and retain top portion for your records - -- --- INVOICE FOR INSPECTION / CERTIFICATE FEES �e State Form 356(R4/9-93) wl i; Approved by the State Board of Accounts-1991 Division of Fire and Building Safety 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online at IDHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https:/I myoracle.in.gov/dfbs/idhsFeesFines/start.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone:(317)232-1921 NUMBER - - --- - - - ANA STATE INDI � CARMEL CLAY PARKS & RECREATION LATEST i PLEASE 304627 ATTN DAWN KOEPPER INVOICE PAY THIS DATE AMOUNT Owner Id 1411 E 116TH ST - --- I li 759531 CARMEL, IN 46032-3455 06/18/2013 ;\✓,. I Owner number User Name&Location of vessel Fee � THE MONON CT I 1 1 1235 CENTRAL PARK DR E $ 25.00 CARMEL IN 46032 Serial number Description of vessel i Manufacturer Date Last Inspected 'IW T Boiler iLOCHINVAR 05/22/2013 i National Board No. Inspection agency Name of inspector (This fee is 181533 TRAVELERS CALHOUN JOSEPH S prescribed by 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due 05/22/2013 CALHOUN JOSEPH S RE-INSPECTION--304627,06/18/2013 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT - -- Tear here and retain top portion for your records ------- INVOICE FOR INSPECTION / CERTIFICATE FEES a" `e State Form 356(R4/9-93) Approved by the State Board of Accounts-1991 Division of Fire and Budding Safety 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online at IDHS web site 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbstidhsFeesFinesistart.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone.(317)232-1921 INDIANA STATE - NUMBER CARMEL CLAY PARKS & RECREATION LATEST PLEASE PAY THIS j 304626 AMOUNT! ATTN DAWN KOEPPER INVOICE DATE AMOUNT!! Owner Id 1411 E 116TH ST ! 759531 CARMEL, IN 46032-3455 06/18/2013 - - Owner number User Name&Location of vessel Fee THE MONON CTR 1235 CENTRAL PARK DR E 25.00 _ CARMEL .IN 46032 i-------- -- el -—- p Serial number Description of vessel j Manufacturer Date Last Ins ected W T Boiler LOCHINVAR 05/22/2013 National Board No. - i Inspection agency i Name of inspector (This fee is i 181626 — TRAVELERS CALHOUN JOSEPH S prescribed by I — - I 675IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due 05/22/2013 CALHOUN JOSEPH S RE-INSPECTION--304626,06/18/2013 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT - -- - --- - - Tear here and retain top portion for your records -------- - ----- INVOICE FOR INSPECTION / CERTIFICATE FEES State Form 356(R4/9-93) j� Approved by the State Board of Accounts-1991 N i Division of Fire and Building Safety You can pay all your payments online at IDHS web site I7_ 1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY 2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https:/I myoracle.in.gov/dfbs/idhsFeesFines/start.do INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on 302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull INDIANAPOLIS IN 46204-2739 up information when paying the dues online. Telephone:(317)232-1921 INDIANA STATE - - - - ! NUMBER CARMEL CLAY PARKS & RECREATION LATEST PLEASE INVOICE PAY THIS 304625 ATTN TERRY MYERS j i I DATE AMOUNT! Owner Id j 1411 E 116TH ST -- 06/18/2013 759531 CARMEL, IN 46032-3455 Owner number User Name&Location of vessel THE MONON CTR I Fee 1 1235 CENTRAL PARK DR E 0 Serial numberV Description 46032 n of vessel Manufacturer Date Last Inspected II W T Boiler iLOCHINVAR 05/22/2013 National Board No. Inspection agency Name of inspector (This fee is 181548 TRAVELERS prescribed b i , CALHOUN JOSEPH S � P Y 675 IAC 12-3-13) Inspection Date Inspector Name Inspection Type Due 05/22/2013 CALHOUN JOSEPH S RE-INSPECTION--304625,06/18/2013 $ 25.00 PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON LINE AND RETURN BOTTOM COPY WITH PAYMENT - - - - - - ---- -- Tear here and retain top portion for your records ----- 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 6/18/13 304631 Boiler inspection $ 25.00 6/18/13 304625 Boiler inspection $ 25.00 —618%13 304626 Boiler inspection $ 25.00 6/18/13 304627 Boiler inspection $ 25.00 6/18/13 304628 Boiler inspection $ 25.00 6/18/13 304629 Boiler inspection $ 25.00 Total $ 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 20_ Clerk-Treasurer Voucher No. Warrant No. 229400 Indiana Department of Homeland Securitv Allowed 20 Fiscal Department 302 W Washington St., Rm E221 Indianapolis, IN 46204 In Sum of$ $ 150.00 ON ACCOUNT OF APPROPRIATION FOR 109 -Monon Center PO#or INVOICE NO. ACCT#[TITLE AMOUNT Board Members Dept# 1093 304631 4350100 $ 25.00 1 hereby certify that the attached invoice(s), or 1093 304625 4350100 $ 25.00 bill(s) is (are)true and correct and that the 1093 304626 4350100 $ 25.00 materials or services itemized thereon for 1093 304627 4350100 $ 25.00 which charge is made were ordered and 1093 304628 4350100 $ 25.00 received except 1093 304629 4350100 $ 25.00 10-Jul 2013 Signature $ 150.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund