249750 09/23/15 CITY OF CARMEL, INDIANA VENDOR: 367222
® i ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $"'"14,459.12"
CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 249750
CHICAGO IL 60686-0020 CHECK DATE: 09/23/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 744203 14,459.12 OTHER EXPENSES
i
Indiana University Health Workplace Services, LLC
950 North Meridian Street
\ Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
August 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Misc.Onsite/August 2015
1 Civic Square
Carmel,IN 46032-
1.00 3,330.99 3330.99
CITYCARO Invoice# 744203 Balance Due: 14459.12
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
SEP 2 12015
Clerk 'Treasurer
Cut and rctum with payment _ — _
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
IU Health Workplace Services, LLC
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
0813 1/1.5 Z44203 — Onsite- A4 sc;August 2015
14,459. 12
Total 14,459.12
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 NQaatm WARRANT NO.
ALLOWED 20
IU Health Workplace Services, LLC IN SUM OF $
2046 Reliable Pkwy
Chicago, IL 60686-0020
$ 14,459.12
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
the materials or services itemized thereon
744203 301 $14,459.12 for which charge is made were ordered and
received except
20
Signature i+P- �tY
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund