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HomeMy WebLinkAbout255545 02/23/16 Y'��"';f. CITY OF CARMEL, INDIANA VENDOR: 370302 �• ONE CIVIC SQUARE VISION SERVICE PLAN CHECK AMOUNT: $""""19,613.67" ,� CARMEL, INDIANA 46032 PO BOX 742788 CHECK NUMBER: 255545 M,�roN�. LOS ANGELES CA 90074.2788 CHECK DATE: 02/23/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 391000 020116 19,613.67 HEALTH INSURANCE PREM VOUCHER NO. WARRANT NO. VISION SERVICE PLAN ALLOWED 20 PO BOX 742788 IN SUM OF$ LOS ANGELES, CA 90074-2788 $19,613.67 ON ACCOUNT OF APPROPRIATION FOR 301 Medical Fund PO#/Dept. INVOICE NO. ACCT#/Fund . - AMOUNT Board Member 02.01.16 I 110-100.00 I $19,613.67 I hereby certify that the attached invoice(s), or 301 301 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, February 15, 2016 Cost distribution ledger classification.if claim paid motor vehicle highway fund J Page 1 1 Account Number: 12 013661 0001 VS Bill Print Date: FEBRUARY 01, 2016 For FEBRUARY 2016 Membership Received After: The 15th of the month will reflect on your next bill. Payment Due Date: Upon receipt of this bill CITY OF CARMEL C/O BENEFIT ADMINISTRATIVE SYSTEMS PAULJOHNSON 1 CIVIC SQUARE CARMEL IN 46032-2584 Prior Billing Period Activity Amount Previously Billed $9,774.75 _Payments/Bill_ing.Adlustments __$0,00.._ Outstanding Receivable Total $9,774.75 Current Billing Period Activity Current Charges $9,838.92 Please Pay This Amount $19,613.67 Submitted To1 -31 Days 32-61 Days 62-91,Days >92 Days $19,613.67 $0.00 $0.00 $0.00` FEB 1 2016 Clerk Treasurer Questions? Please call 1-866-213-2249 if you have questions regarding your bill or membership. Passion for people. Vision for life. sm