HomeMy WebLinkAbout257104 04/05/16 CITY OF CARMEL, INDIANA VENDOR: 364990
® 31• ONE CIVIC SQUARE C H C WELLNESS CHECK AMOUNT: 6"""12,540.00'
CARMEL, INDIANA 46032 5440 N CUMBERLAND AVE#225 CHECK NUMBER: 257104
CHICAGO IL 60656 CHECK DATE: 04/05/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 WP2740 12,540.00 OTHER EXPENSES
3rescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
03/21/16 I WP2740 I Walking Program Participant Fees I $12,540.00
301 301
1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
C H C WELLNESS
5440 N CUMBERLAND AVE#225
IN SUM OF$
CHICAGO, IL 60656
$12,540.00
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Fund
PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members
WP2740 I 50-239.90 I $12,540.00 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
Monday, March 28, 2016
Cost distribution ledger classification if
claim paid motor vehicle highway fund
5440 N. Cumberland Ave., Suite 225 INVOICE
�}` Chicago, IL 60656
TEL: 847.640.4440 Invoice# wP2740
FAX: 847.437.2770
www.chcw.com Date 3/21/2016
Ship 3/21/2016
Bill To Terms Net 30
City of Carmel Rep Ron
Attn:Sue Wolfgang
1 Civic Square Due Date 4/20/2016
Carmel,IN 46032
Quantity Item Code Description Price Each Amount
2016 Walking Program:
209 Walk Walking Program Participant Fee 60.00 12,540.00
Submitted To
MAR 2 8 2016 -
a
Clerk
,rT reasurer
Thank you for your business. Invoice Total $12,540.00
PLEASE MAKE CHECK PAYABLE TO: CHC WELLNESS Payments/Credits $0.00
REMITTANCE ADDRESS:
5440 NORTH CUMBERLAND AVE., SUITE 225
CHICAGO, IL 60656 Balance Due $12,540.00