248381 08/1 2/1 5 CITY OF CARMEL, INDIANA VENDOR: 00352999
ONE CIVIC SQUARE HYLANT GROUP
CHECK AMOUNT: $****'**100.00*
CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 248381
(9,
CINCINNATI OH 45263-8720 CHECK DATE: 08/12/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1801 4347500 68014 100.00 GENERAL INSURANCE
Item# Trans Eff Date Due Date Trans Descripfion J ;Amount
! _ two.
BOND-Other(Specify) Policy# 105580255 Effective: 12/31/14 12/31/15
Issuing Company Travelers Cas &Surety of Amer
432093 12/31/2014 12/31/2014 R EN B 100.00
60� D
QA-2-e�l
Total Invoice Balance: $100:00
**PLEASE NOTE REMITTANCE ADDRESS CHANGE**
�I►HYLANT Hylant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
12/31/20 Insured Carmel Redevelopment Comm Loan# Invoice#68014 UBAMAI Page 1 of 1
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form 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
\I l\Y\ Purchase Order No.
��� I�nhs`�,Vdn\L\ I���r�l . )tf,�►�e `��� Terms
T VAI \ 15 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
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
20Clerk-Treasurer
VOUCHER NO. WARRANT NO.
1 ALLOWED 20
IN SUM OF $
'W Q�r,r;s 1\\rlr��, 1Kyr•l . 7cA1 � `Z��
a
i
$
ON ACCOUNT OF APPROPRIATION FOR
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
' the materials or services itemized thereon
for which charge is made were ordered and
received except
20\5
Sig atired
0"? �PoLxkx
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund