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243465 03/24/15 z,.ceA,� CITY OF CARMEL, INDIANA VENDOR: 364990 jg ® ONE CIVIC SQUARE C H C WELLNESS CHECK AMOUNT: $****19,740.00* s. r° CARMEL, INDIANA 46032 5440 N CUMBERLAND AVE#225 CHECK NUMBER: 243465 ���ioe`�� CHICAGO IL 60656 CHECK DATE: 03/24/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 WP2739 19,740.00 OTHER EXPENSES U l 5440 N. Cumberland Ave., Suite 225 INVOICE © Chicago, IL 60656 TEL: 847.640.4440 Invoice# WP2739 WELLNESS FAX: 847.437.2770 www.chcw.com Date 3/6/2015 Ship 3/6/2015 Bill To Terms Net 30 City of Carmel Rep Ron Attn: Sue Wolfgang 1 Civic Sq. Due Date 4/5/2015 Carmel,IN 46032 Quantity Item Code Description Price Each Amount 2015 Walking Program: 329 Walk Walking Program Participant Fee 60.00 19,740.00 10 ped Pedometers 0.00 0.00 To MAR 2 3 2015 Clerk 'Treasurer Thank you for your business. Invoice Total $19,740.00 PLEASE MAKE CHECK PAYABLE TO: CHC WELLNESS REMITTANCE ADDRESS: 5440 NORTH CUMBERLAND AVE., SUITE 225 CHICAGO, IL 60656 Prescribed by State Board of Accounts 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 CHC Wellness Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 19,740.00 03106115 P2739 _ _ 19 740.00 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 IClerk-Treasurer VOUCHER NO.03/23/15 WARRANT NO. i CHC Wellness ALLOWED 20 IN SUM OF $ 5440 N. Cumberland Ave, Suite 225 Chicago, IL 60656 I $ 140.00 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 WP2739 301 19,740.00 the materials or services itemized thereon for which charge is made were ordered and received except I 20 I n Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund