HomeMy WebLinkAbout303133 09/15/16 (9,
CITY OF CARMEL, INDIANA VENDOR: 370302
ONE CIVIC SQUARE VISION SERVICE PLAN CHECK AMOUNT: $*****9,641.83*
CARMEL, INDIANA 46032 PO BOX 742788 CHECK NUMBER: 303133
LOS ANGELES CA 90074-2788 CHECK DATE: 09/15/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 09.01.16 9,641.83 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
VISION SERVICE PLAN ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PO BOX 742788 IN SUM OF$ 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.
$9,641.83 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
09.01.16 50-239.90 $9,641.83 1 hereby certify that the attached invoice(s),or 9/1/16 09.01.16 $9,641.83
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
Tuesday,September 13,2016
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
Page 1
® 1
Account Number: 12 013661 0001 VS
Bill Print Date: SEPTEMBER 01, 2016 For SEPTEMBER 2016
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
BARBARA LAMB
1 CIVIC SQUARE
CARMEL IN 46032-2584
Prior Billing Period Activity
Amount Previously Billed $9,664.87
Payments/Billing Adjustments -$9,664.87 _
Outstanding Receivable Total $0.00
Current Billing Period Activity
Current Charges $9,641.83
Please Pay This Amount $9,641.83
1 -31 Days 32'7 61 Days 62-91 Days >92 Days
$9;641.83 $0.00 $0.00; $0.00
Submitted To
SEP 132116
Clerk `fir,masurer
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
•
•
1 This billing statement Pagel VS P.
includes membership Account Number. 110000000001
processed by VSP Bill Print Date August 18,2000 For September 2000
through the date Membership Processed After. 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 Days 32-61 Days 62-91 Days 92 days-
$52:00' $5.00 $7.00 $o.o0 8 Please complete and
return the payment
coupon to the VSP
4 Total charges for this � �- ddress on the
billing cycle. 6 VSP appreciates your business. abottom of the billing
statement.
9
Total charge/amount due
5 Outstanding receivable 7 for this billing cycle.
detail section. Passion for People.Vision for L fe.
.......................................................................................................................................
Please detach and 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
Amount Due $64.00
$ Return To: 9
VSP-(CA) Amount Paid $
P.O.Box 45210
San Francisco,CA 94145-5210 10 Number Paid for