HomeMy WebLinkAbout236138 08/19/14 S
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CITY OF CARMEL, INDIANA VENDOR: 362339
ONE CIVIC SQUARE CITIZENS MANAGEMENT INC CHECKAMOUNT: S""'15,897.49"
CARMEL, INDIANA 46032 PO BOX 620 CHECK NUMBER: 236138
HOWELL MI 48844-0620 CHECK DATE: 08/19/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
302 5023990 08.18.14 15,897.49 OTHER EXPENSES
Aug, 15. 2014 2: 14PM No. 4942 P. 2/3
C.."�M1-1 CMI PO Sox 620,Howell,MI 48844.0620 Loss Fund Invoice
TO: MS.SHELLY M.LINGELBAUGH
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL,IN 46032
DATE: 08/15/2014
LOSS FUND INVOICE - DUE UPON RECEIPT
REFERENCE#: SWC0000385
INITIAL DEPOSIT $25,000,00
08/15/2014 BALANCE $9,102,51
AMOUNT DUE $15,897,49
PLEASE(VOTE.We are forbidden bylaw to issue checks
should your Loss Fund balance become zero.
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
CITIZENS MANAGEMENT INC Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
nam am Loss Fund Invoice 15,897.
49
4 nR 1R 14
Total $15'
891.
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 N �A WARRANT NO.
f''� ALLOWED 20
CITIZENS MANAGEMENT INC IN SUM OF $
PO Box 620
Howell, MI 48844-0620
$ $15,897-49
ON ACCOUNT OF APPROPRIATION FOR
I
i
302 WORK COMP FUND
Board Members
DEPT.PO# a INVOICE NO. ACCT#!TITLE AMOUNT i I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
08.18.14 302 $15,897.49 materials or services itemized thereon for
which charge is made were ordered and
received except
I
20
f �
Signat r
Cost distribution ledger classification if
� Title
claim paid motor vehicle highway fund