HomeMy WebLinkAbout256194 03/11/16 �o!—�qM
�.. CITY OF CARMEL, INDIANA VENDOR: 370302
;; ® ii ONE CIVIC SQUARE VISION SERVICE PLAN CHECK AMOUNT: $"''`9,619.22•
:. �� CARMEL, INDIANA 46032 PO BOX 742788 CHECK NUMBER: 256194
9�'�roN�°'` LOS ANGELES CA 90074-2788 CHECK DATE: 03/11/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 391000 030116 9,619.22 12 013661 0001
VOUCHER NO. WARRANT NO.
ALLOWED 20
VISION SERVICE PLAN
PO BOX 742788 IN SUM OF$
LOS ANGELES, CA 90074-2788
$9,619.22
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Fund
PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members
03.01.16 I 110-100.00 I $9,619.22 1 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
Tuesday, March 08, 2016
Cost distribution ledger classification if
claim paid motor vehicle highway fund
'rescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
4n 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 Date invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
03/01/16 03.01.16 March 2016 $9,619.22
301 301
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
Page 1 �
• 1
Account Number: 12 013661 0001 VS
Bill Print Date: MARCH 01, 2016 For MARCH 2016 e
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 $19,613.67
Payments/Billing Adjustments $0.00
Outstanding Receivable Total $19,613.67________. _
Current Billing Period Activity
Current Charges $9 619 22
Please Pay This Amount $29,232.89
1.-31 Days 32--61`Days 62-1-191`Days, >92 Days
$19,458.14 $9,774.75 $0:00,
Submitted TTo
MAR 0 8 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
How to Read the First Page of
Your Billing Statement
VSP
1 This billing statement Page 1
includes membership Account Number: 110000000001
processed by VSP Bill Print Date August 18,2000 ForSeptember2000
through the date Membership Processed Atter: The 15th of the month will reflect on your next bill.
g Payment Due Date: Upon receipt of this statement 6 Messages regarding
displayed here, your payment,billing
statement,or
Sample Bill
Employee Benefits Department 2 Prior Billing Period Activity $57.00 membership,if any.
2 Amount billed on the 1234 Quality Circle Amount Previously Billed -$40.00
last billing statement. Anywhere,CA 98560-4855Payments/Billing Adjusments -$5.00
3 Outstanding Receivable Total $12.00
Current Billing Period Activity 7 VSP contact
information for billing
3 Manually processed 4 Current Charges $52.00 and membership
adjustments since Please Pay This Amount $64.00 questions.
your last billing
statement. 5 0 31'Da9s —32 -611'D-ays '62:'91 Days"""">92 days-, — --
$s2.00 $5.00- �F. $7 00 $0.00 8 Please complete and
return the payment
coupon to the VSP
4 Total charges for this address on the
billing cycle. 6 VSP.appreciates your business.
9 y bottom of the billing
statement.
Total charge/amount due
5Outstanding receivable 7 9 for this billing cycle.
detail section. Passion for People.Vision for Life;
.......................................................................................................................................
Pleasedetafhand return this portion with your payment Total number of
Bill Print Date:August 18,2000 For September 2000 10 members/employees paid
Group Name: Sample Bill Attn:Karen D.Service for this billing cycle.
Account Number(s): 11 000000 0001
$ Return To: 9 Amount Due $64.00
VSP-(CA) Amount Paid $
P.O.Box 45210
San Francisco,CA 94145-5210 10 Number Paid for