HomeMy WebLinkAbout233766 06/18/14 (9,
CITY OF CARMEL, INDIANA VENDOR: 00352999
ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $****22,975.00*
CARMEL, INDIANA 46032 301 PENNSYLVANIA PKWY,SUITE 201 CHECK NUMBER: 233766
INDIANAPOLIS IN 46280 CHECK DATE: 06/18/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
302 5023990 06. 02.14 22,975.00 OTHER EXPENSES
Please Return Top with Remittance To: 301 Pennsylvania Pkwy,Ste 201,Indianapolis,IN 462800925
item# g Trans EffDae��� Due Dat�`� 'Trans � bescript�oi� '' � '- �� s� `� ' s�Amount
Third Party Administrator-Commercia Policy# 0385 Effective: 111/14 - 1/1/15
Issuing Company Midwest Employers Casualty Co
186648 1/1/2014 7/1/2014 RENB TPAC 2 of 2 Semi-Annual 22,975.00
Total Invoice Balance: $22,975.00
Submitted To
JUN 16 2014
Clerk Treasurer
HYL ;NT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
6/2/2014 Insured City of Carmel Loan# Invoice#35338 UBAMAI Page 1 of 1
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
HYLANT GROUP
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
06/02/14 06.02.14 Third Party Admin - Commercial Policy#385 $22,975.00
Total $22,975.00
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.06/16/14 WARRANT NO.
ALLOWED 20
HYLANT GROUP
� IN SUM OF $
i
301 Pennsylvania Parkway, Suite 201
Indianapolis, IN 46280
$ $22,975.00
ON ACCOUNT OF APPROPRIATION FOR
302 WORK COMP FUND
Board Members
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
06.02.14 302 $22,975.00 materials or services itemized thereon for
01.03.14 302 $0.00 which charge is made were ordered and
received except
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund