HomeMy WebLinkAbout238134 10/15/2014 (9,
CITY OF CARMEL, INDIANA VENDOR: 367222
ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: S""**'720.00*
CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER:. 238134 CHICAGO IL 60686-0020 CHECK DATE: 10/15/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 736393 720.00 GENERAL INSURANCE
Indiana University Health Workplace Services,LLC
950 North Meridian Street
Suite 200 (City of Carmel)
5 Indianapolis, IN 46204
Phone: 317-963-1534
FEIN: 20-0994452
Invoice
October 01, 2014
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite EAP Services/Sept.2014
1 Civic Square
Carmel,IN 46032-
Invoice# 736393
Proc Code Date Descti tp ion 11ty Charge Receipt Adiust Balance
EAPSERV 09/01/2014 EAP Services 600.00 720.00 720.00
600 Employees
Balance Due: 720.00
Invoice# 736393 Balance Due: 720.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE
DATE-PLEASE INCLUDE INVOICE#ON CHECK
Submitted To
OCT 42014
Clark Treasurer
Cut and return with payment
VOUCHER NO. WARRANT NO.
ALLOWED 20
IU Health Workplace Services, LLC
IN SUM OF$
2046 Reliable Pkwy
Chicago, IL 60686-0020
$720.00
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 I 736393 I 43-475.00 I $720.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Monda ,10ctober 13, 2014
rz
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
10/01/14 736393 EAP Services $720.00
I 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