251279 11/04/15 o•."qM
CITY OF CARMEL, INDIANA VENDOR: T0002825
ONE CIVIC SQUARE UNITED HEALTHCARE CHECK AMOUNT: $*******425.59*
?� CARMEL, INDIANA 46032 GREENSBORO SMALL GROUP CHECK NUMBER: 251279
PO BOX 740800 CHECK DATE: 11/04/15
ATLANTA GA 30374
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 425.59 REFUND
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JAMES BRAINARD, MAYOR
November 2, 2015
UNITED HEALTHCARE - -
GREENSBORO SMALL GROUP
P O BOX 740800
ATLANTA, GA 30374-0800
RE: RUN#20151730:1 DOS 04/11/2015
Dear United Healthcare Claims Department:
Enclosed you will find a refund check for$425.59
We received your check#QC 59521251 for$425.59 for this invoice.
On 5/27/2015 Travelers processed this claim and paid$425.59.
Duplicate payments created overpayment on this account.
Refund is owed to United HealthCare.
If you have any questions, please feel free to contact me at (317) 571-2604.
Sincerely,
Michelle T. Harrington
EMS Billing Administrator
CARMEL FIRE DEPARTMENT
STEVEN A. CouTS HEADQUARTERS
Two Cmc SouARE. CARMEL. IN 46032 OFFICE 317.571.2600. FAx 317.571.2615
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
Purchase Order No.
Terms
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 accordance
with IC 5-11-10-1.6.
, 20-
Clerk-Treasurer
20Clerk-Treasurer
VOUCHER NO. WARRANT NO. 1
ALLOWED 20
IN SUM OF $
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
NOY
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund