HomeMy WebLinkAbout246362 06/17/15 1y ur-.4�gyP
�i �. CITY OF CARMEL, INDIANA VENDOR: 00352999
` �� ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $****22,975.00"
CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 246362
v\. /t. CINCINNATI OH 45263-8720 CHECK DATE: 06/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
302 5023990 65912 22,975.00 OTHER EXPENSES
Hylant-Indianapolis Invoice # 65912
/ 301 Pennsylvania Pkwy,Ste 201
I HYLANT p
Indianapolis,IN 46280
P-(800)678-0361 n OY`" 6/1/2015 r 7/1/2015
hylant.com F-(317)817-5151 /
City of Carmel
Account Number Amount Due
Zv� CARMELO-02 $22,975.00
City of Carmel
Attn: STEVE ENGELKING
One Civic Square
Carmel, IN 46032
Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720 ***NEW ADDRESS**.
Third Party Administrator-Commercia Policy# 0385 Effective: 1/1/15 - 1/1/16
Issuing Company Midwest Employers Casualty Co
414924 1/1/2015 7/1/2015 RENB TPAC 2 of 2 Semi-Annual 22,975.00
Total Invoice Balance: $22,975.00
**PLEASE NOTE REMITTANCE ADDRESS CHANGE**
FSubmitted T®
15 2015
Clerk Treasurer
4 HYLANT' Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
6/1/2015 City of Carmel Loan# Invoice#65912 LIBAMA1 Page 1 of 1
L
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
06/01/15 35912 Policy 0385 22 975.00
Total $22,975.00
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 NfWjS&&-WARRANT NO.
i
i ALLOWED 20
HYLANT IN SUM OF $
P.O. Box 638720 {
Cincinnati, OH 45263-8720
f�
11�
I
$$22,975.00
ON ACCOUNT OF APPROPRIATION FOR
.1
302 WORK COMP FUND
Board Members
i
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
65 12 302 22,975.00 i the materials or services itemized thereon
for which charge is made were ordered and
received except
20
Signa ire
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund