300377 07/14/16 c,q
CITY OF CARMEL, INDIANA VENDOR: 370 02
1' ONE CIVIC SQUARE VISI N SERVICE PLAN CHECK AMOUNT: $*****9,344.30*
s a CARMEI„ INDIANA 46032 PO B x 742788 CHECK NUMBER: 300377
LOS NGELES CA 90074.2788 CHECK DATE: 07/14/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NU BER AMOUNT DESCRIPTION
301 5023990 070116 9,344.30 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
VISION SERVICE PLAN ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PO BOX 742788 IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
LOS ANGELES, CA 90074-2788 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$9,344.30 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
301 Medical Fund Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
07.01.16 50-239.90 $9,344.30 1 hereby certify that the attached invoice(s),or 7/1/16 07.01.16 $9,344.30
301 301 301 301
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which c arge is ma a were or ere a
received except
Tuesday,July 12,2016 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—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
r
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Account Number: 12 013661 0001 VS
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Bill Print Date: JULY 01, 2016 For JULY 2016
Membership Received After: The 15th of the month wil reflect on your next bill.
Pa ment Due Date: Upon receipt of this bill
CITY OF CARMEL C/O
BARBARA LAMB
1 CIVIC SQUARE
CARMEL IN 46032-2584
Prior Billing Period Activity
Amount Previously Billed $9,636.49
Payments/Billing Adjustments -$9,936.49
-Outstanding-Receivable Total — --- --Current Billing Billing Period Activity
Current Charges $9,644.30
Please Pay This Amount $9,344.30
Sllbi�li7To 1 '31 Days 32 `61 Days 62 91'Days
$9;344.30.` .$000 $0.00 -t6.00
JUL 1
Clerk Treasurer
Questions? Please call 1-866-213-2249 if yo i have questions regarding your bill or membership.
Passion for l6.,Vision for life.sm
RoP