HomeMy WebLinkAbout300871 07/21/16 (9,
CITY OF CARMEL, INDIANA VENDOR: 00350010
ONE CIVIC SQUARE TE ESA RICKARD CHECK AMOUNT: $**'****300.00*
CARMEL, INDIANA 46032 53s ALLORY HILL DRIVE CHECK NUMBER: 300871
THE ilLLAGESFL 32162 CHECK DATE: 07/21/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NU14BER AMOUNT DESCRIPTION
301 5023990 071816 300.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
TERESA RICKARD ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
539 MALLORY HILL DRIVE IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
THE VILLAGES, FL 32162 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$300.00 Payee
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
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
071816 50-239.90 $300.00 1 hereby certify that the attached invoice(s),or 7/18/16 071816 Health Savings Account Incentive $300.00
301 301 301 301
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,July 18,2016
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 distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
City of Carmel Employee Health Benefit Plan
Health Saving Account Incentive
The retired plan participant listed below has Ilected.Plan A for 2016 and is eligible for a bi-
annual contribution to his or her HSA account, as authorized by Resolution BPW-10-03-12-02.
Payroll: Please return check to Human Reso rces for distribution.
Plan Participant/Payee:
Teressa Rickard
539 Mallory Hill Drive
The Villages,FL 32162
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: July 18,2016