249732 09/23/15 o F4q '
CITY OF CARMEL, INDIANA VENDOR: 00352999
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® ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $""**""678.55*
CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 249732
CINCINNATI OH 45263-8720 CHECK DATE: 09/23/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 91059 678.55 GENERAL INSURANCE
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Please Return Top with Remittance To: PO Box 638720, Cincinnati, OH 45263-8720 NEW ADDRESS
rar
General Liability Policy# 2778611312 Effective: 9M3115 9/14V15
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Issuing Company Burlington Insurance Company
| 626080 0/13/2015 9/15/2015 NEVV8 SPECIAL EVENT GENLL|A8-CARMEL PORCH 027.00
FEST
628970 013/2015 8/15/2015 CFEE POLICY FEE 35.00
020971 9V13/2015 8/15/2015 CFEX INDIANA SURPLUS LINES TAX 16.55
Total Invoice Balance: $678.55
"PLEASE NOTE REMITTANCE ADDRESS CHANGE"
4HYLANT Hyiant-Indianapolis 301 Pennsylvania Pkwy,Ste 201 Indianapolis IN 46280
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
09/15/16 91059 $678.55
1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Hylant Group
IN SUM OF $
PO Box 638720
Cincinnati, OH 45263-8720
$678.55
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Prior j""r I hereby certify that the attached invoice(s), or
1205 91059 I 43-475.00 I $678.55
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
Monday, September 21, 2015
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund