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226786 12/03/2013
CITY OF CARMEL, INDIANA VENDOR: 362028 Page 1 of 1 ONE CIVIC SQUARE PREMIUM INSPECTION SERVICES CARMEL, INDIANA 46032 CHECK AMOUNT: $300.00 ' •io 7605 FOREST DRIVE FISHERS IN 46038 CHECK NUMBER: 226786 CHECK DATE: 12/3/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4350900 36213 111420136395 300 . 00 MOLD INSPECTION SERVI p¢e INVOICE � P F#_ 1114201363950 rr ;i I�TSPF.CTIQj�� SERVICES -I- I 7605 Forest Dr 317-536-8369 NOV 2019 Fishers, IN 46038 S,%)�_ THE INSPECTION REPORT WILL NOT BE RELEASED-UNTIL-=ALL SERVICES=HAVE BEEN PAID IN FULL. DATE OF INVOICE: November 15, 2013 ZQ; INSPECTION ADDRESS Carmel Clay Parks - c/o Dawn 1427E 116th St PO i 3L,33'-/ Carmel IN 46032 DATE: TYPE OF INSPECTION: AMOUNT: 11/15/2013 3 Mold Samples $0.00 $300.00 IvN1� �rjWCVon A-0 Vol 1125�-OZ-�-35cq©a J TOTAL FEES: $300.00 PAYMENTS ate____,�mount_ Check-# CHECK: CREDIT CARD: # EXPIRATION DATE: SECURITY CODE: CURRENT ZIP CODE: PAYMENTS: � SIGNATURE: BALANCE DUE: $300.00 Premium Inspection Services 1114201363950 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. 362028 Premium Inspection Services Terms 7605 Forest Dr Fishers, IN 46038 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO # Amount 11/15/13 1114201363950 Mold inspection AO 36213 $ 300.00 Total $ 300.00 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. 362028 Premium Inspection Services Allowed 20 7605 Forest Dr Fishers, IN 46038 In Sum of$ $ 300.00 ON ACCOUNT OF APPROPRIATION FOR 101 -General Fund PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 36213 F 111420136395 4350900 $ 300.00 1 hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 27-Nov 2013 Signature $ 300.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund