HomeMy WebLinkAbout241303 01/22/15 Q
CITY OF CARMEL, INDIANA VENDOR: 00352999
ONE CIVIC SQUARE HYLANT GROUPCHECKAMOUNT: S*******600.00*
CARMEL, INDIANA 46032 301 PENNSYLVANIA PKWY,SUITE 201 CHECK NUMBER: 241303
INDIANAPOLIS IN 46280 CHECK DATE: 01/22/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
302 5023990 600.00 OTHER EXPENSES
Please Return Top with Remittance To: 301 Pennsylvania Pkwy,Ste 201,Indianapolis,IN 462800926
Amon'#
Workers'Compensation Policy# BLO465905401 Effective: 111/15 111/16
Issuing Coin pany Great American E&S Ins Co
436308 1/112015 111312015 RENS CORRECT PREM WC BUFFER LAYER 600.00
Total Invoice Balance: $600.00
"PLEASE NOTE REMITTANCE ADDRESS CHANGE"
Submitted To
JAN 19 2014
Clark Treasurer
AP HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
1/1 3/201 Insured City of Carmel Loan# Invoice#68929 UBAMAI Page I of 1
........... ....... ..........
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Forth 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))
01/13/15 68929 Policy BL0465905401
Total $600.00
1 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 NQuig i5 WARRANT NO.
ALLOWED 20
HYLANT GROUP
IN SUM OF $
301 Pennsylvania Parkway, Suite 201
Indianapolis, IN 46280
$$600.00
I
ON ACCOUNT OF APPROPRIATION FOR
302 WORK COMP FUND
iBoard 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
68929 302 600.00 i the materials or services itemized thereon
for which charge is made were ordered and
received except
i
i
i
I
20
Sig ature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund