HomeMy WebLinkAbout231178 04/08/14 ;i�`�,°f( CITY OF CARMEL, INDIANA VENDOR: 364990
(; ® i'r ONE CIVIC SQUARE C H C WELLNESS CHECK AMOUNT: $****16,040.00*
?4 CARMEL, INDIANA 46032 5440 N CUMBERLAND AVE#225 CHECK NUMBER: 231 178
'+,,ETON La. CHICAGO IL 60656 CHECK DATE: 04/08/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 C2547 850.00 OTHER EXPENSES
301 5023990 WP2112 15,190.00 OTHER EXPENSES
5440 N. Cumberland Ave., Suite 225 INVOICE
M
In a� Chicago, IL 60656 lel
TEL: 847.640.4440 Invoice# WP2112
FAX: 847.437.2770
-%v\v-,v.chcw.com Date 3/19/2014
Ship 3/19/2014
Bill To Terms Net 30
City of Cannel Re Ron
Attn: Barbara Lamb p
1 Civic Square
Due Date 4/18/2014
Cannel, IN,46032
Quantity Item Code Description Price Each Amount
Walking Program:
217 Walk Walking Program Participant Fee 70.00 15,190.00
18 Rped Replacement Pedometers 0.00 0.00
77 WLKSF Walking Program Set-up Fee including New Pedometer 0.00 0.00
Submitted To
APR 72014
Clerk `treasurer
Thank you for your business. Invoice Total $15,190.00
PLEASE MAKE CHECK PAYABLE TO: CHC WELLNESS
REMITTANCE ADDRESS:
5440 NORTH CUMBERLAND AVE., SUITE 225
CHICAGO, IL 60656
5440 N. Cumberland Ave., Suite 225 INVOICE
Chicago, IL 60656
TEL: 847.640.4440 Invoice# C2547
FAX: 847.437.2770
«,\vxv.chcw.com Date 11/7/2013
Ship 1/15/2014
Bill To Terms Net 30
City of Cannel
Attn: Barbara Lamb Rep Ron
I Civic Square Due Date 12/7/2013
Cannel,IN,46032
IA Quantity Item Code Description Price Each Amount
Wellness Screenings for City of Carmel Employees
Not On Company BAS PPO Plan
2 H&W-Company Health and Wellness-Carmel City Hall- 11/7/2013 170.00 340.00
-Mary Evans
-Lisa Stewart
2 H&W-Company Health and Wellness-Cannel City Hall- 11/8/2013 170.00 340.00
Lisa Motz
Todd Utzig
I H&W-Company Health and Wellness-Water Distribution- 11/13/2013 170.00 170.00
-Brett Ransford
Please see roster for detailed breakdown
Submitted To
APR 72014
Clerk Treasurer
Past Due Invoice Invoice Total $850.00
PLEASE MAKE CHECK PAYABLE TO: CHC WELLNESS
REMITTANCE ADDRESS:
5440 NORTH CUMBERLAND AVE., SUITE 225
CHICAGO, IL 60656
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
CITY OF CARMEL
An invoice or 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
CHC Wellness Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
03/19/14 WP2112 Walking Pro ram 0 Do
Total $16,040.00
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.
120-
Clerk-Treasurer
20Clerk-Treasurer
VOUCHER AY3114WARRANT NO. '
ALLOWED 20
C,HC Wellness IN SUM OF $
5440 N. Cumberland Ave., Suite 225
Gk *cagoT1 L 60656
$11 F�(ln
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Fund
Board Members
PO#or
DEPT# INVOICE NO. ACCT#!TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
C2547 50.00 materials or services itemized thereon for
%AIP91 19 115,190-00 which charge is made were ordered and
received except
20
Signature
✓��v � tom.,
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund