HomeMy WebLinkAbout237149 09/16/14 CITY OF CARMEL, INDIANA VENDOR: 00352999
{ ® 31 ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $****'*5,892.00*
CARMEL, INDIANA 46032 301 PENNSYLVANIA PKWY,SUITE 201 CHECK NUMBER: 237149
gMiron INDIANAPOLIS IN 46280 CHECK DATE: 09/16/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
302 5023990 09.11.14 5,892.00 OTHER EXPENSES
Please Return Top with Remittance To: 301 Pennsylvania Pkwy,Ste 201,Indianapolis,IN 462800925
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Amount
Workers'Compensation Policy# WCX002887 Effective-. 111112 111/14
issuing Company Citizens Insurance Co of America
352071 111/2012 9/11/2014 AUDI AUDIT-WORKERS COMP Ill/13-14 5,892.00
Total Invoice Balance: $5,892.00
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SEP 2 9 2 2014flJ4
Clerk Treasurer
A.HYLANIT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
gl,,,,/2()l Insured City of Carmel Loan# Invoice#58441 UBAMA1 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))
09/11/14 09.11.14 CARMELO-02
Total $5,892.00
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 NQ?a5tja WARRANT NO.
ll ALLOWED 20
HYLANT GROUP I' IN SUM OF $
301 Pennsylvania Parkway, Suite 201
Indianapolis, IN 46280
$ $5,892.00
ON ACCOUNT OF APPROPRIATION FOR
302 WORK COMP FUND
Board Members
PO#or D PT.# INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
09.11.14 302 $5,892.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund