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HomeMy WebLinkAbout234466 07/08/14 (9, CITY OF CARMEL, INDIANA VENDOR: 00350917 ONE CIVIC SQUARE KIM ROTT CHECK AMOUNT: $*******400.00* CARMEL, INDIANA 46032 1303 HOLLYCREST DRIVE CHECK NUMBER: 234466 BLOOMINGTON IL 61701 CHECK DATE: 07/08/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 400.00 HSA INCENTIVE City of Carmel Employee Health Benefit Plan Health Savings Account Incentive The retired plan participant listed below has elected Plan A for 2014 and is eligible for a bi- annual contribution to his or her HSA account, as authorized by Resolution BPW-10-03-12-02. Please return check to Human Resources for further processing. Plan Participant/Payee: Kimberly Rott 1303 Hollycrest Drive Bloomington,IL 61701 Amount: $400.00 Fund: Medical Escrow Fund (301) Date: July 7,2014 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 Kimberly Rott Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 0710711 07.07.14 $400.0- Health Savings Account Incenthin Total $400.00 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 20Clerk-Treasurer VOUCHER NOo7/07/14 WARRANT NO. ALLOWED 20 Kimberly Rott j IN SUM OF $ 1303 Hollycrest Drive Bloomington, IL 61701 $ $400.00 i. 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 07.07.14 301 $400.00 materials or services itemized thereon for which charge is made were ordered and received except 20 j Signature Cost distribution ledger classification if ! Title claim paid motor vehicle highway fund