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
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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