HomeMy WebLinkAbout300818 07/21/16 �`% �,AZ;� CITY OF CARMEL, INDIANA VENDOR: 368374
® �• ONE CIVIC SQUARE RITA COLLINS CHECK AMOUNT: $*******300.00*
;� _� CARMEL, INDIANA 46032 4389 ELKHORN DRIVE CHECK NUMBER: 300818
.y,�TON moo, WESTFIELD IN 46062 CHECK DATE: 07/21/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 071816 300.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
RITA COLLINS ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
4389 ELKHORN DRIVE IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
W ESTFI ELD, IN 46062 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$300.00 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
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 Savings Account Incentive
The retired plan participant listed below has elected 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 Resources for distribution.
Plan Participant/Payee:
Rita Collins
4389 Elkhorn Drive
Westfield,IN 46062
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: July 18,2016