HomeMy WebLinkAbout241233 01/22/15 CAA .
CITY OF CARMEL, INDIANA VENDOR: 364990
a;
r ® ONE CIVIC SQUARE C H C WELLNESS CHECK AMOUNT: $*****1,012.00*
CARMEL, INDIANA 46032 5440 N CUMBERLAND AVE#225 CHECK NUMBER: 241233
CHICAGO IL 60656 CHECK DATE: 01/22/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 C2930 1,012.00 OTHER EXPENSES
3,P1
5440 N. Cumberland Ave., Suite 225 INVOICE
Chic ago, IL 60656
TEL: 847.640.4440
low, FAX: 847.437.2770 Invoice# C2930
NNvA'xv.chcW.com
Date 1/13/2015
Ship 1/13/2015
Bill To Terms Net 30
City of Carmel
Attn:Barbara Lamb Rep Ron
I Civic Square
Carmel,IN 46032 Due Date 2/12/2015
Quantity Item Code Description Price Each Amount
Wellness Screenings for City of Carmel Employees
Not On Company BAS PPO Plan
2 H&W-Company Health&Wellness-Carmel City Hall- 12/2/2014 170.00 340.00
-Lisa Motz
-Marguerite Crediford
1 THYROID TSH 42.00 42.00
-Marguerite Crediford
2 H&W-Company Health&Wellness-Water Distribution- 12/03/2014 170.00 340.00
-Brett Ransford
-Andrew Dockery
2 PSA PSA 39.00 78.00
-Brett Ransford
-Andrew Dockery
I THYROID TSH 42.00 42.00
-Brett Ransford
1 H&W-Company Health&Wellness-Carmel City Hall- 12/9/2014 170.00 170.00
-Lisa St
Submitted To
JAN 1.9 2014
Clerk Treasurer
Thank you for your business. Invoice Total $1,012.00
PLEASE MAKE CHECK PAYABLE TO: CHC WELLNESS
REMITTANCE ADDRESS:
5440 NORTH CUMBERLAND AVE., SUITE 225
CHICAGO, IL 60656
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City FormNo.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
CHC Wellness Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
$1,012.00
01113115 2
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER I`Qqpjj.5_WARRANT NO.
ALLOWED 20
CHC Wellness
IN SUM OF $
5440 N. Cumberland Ave., Suite 225
Chicago IL 60656
$/,012.00
ON ACCOUNT OF APPROPRIATION FOR
301 Medical 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
C2930 $ ,012.00 the materials or services itemized thereon
for which charge is made were ordered and
received except
20
Signature
b i vIw+-.0-✓
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund