HomeMy WebLinkAbout304217 10/13/16 CITY OF CARMEL, INDIANA VENDOR: 370302
® \; ONE CIVIC SQUARE VISION SERVICE PLAN CHECK AMOUNT: $*****9,622.09*
CARMEL, INDIANA 46032 PO BOX 742788 CHECK NUMBER: 304217
LOS ANGELES CA 90074-2788 CHECK DATE: 10/13/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 100316 9,622.09 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995)
VISION SERVICE PLAN ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PO BOX 742788 IN SUM OF$ 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.
$9,622.09 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
10.03.16 50-239.90 $9,622.09 1 hereby certify that the attached invoice(s),or 10/3/16 10.03.16 $9,622.09
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
Wednesday, October 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 distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Page 1
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Account Number: 12 013661 0001 VS
Bill Print Date: OCTOBER 03, 2016 For OCTOBER 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 $9,641.83
Payments/Billing Adjustments -$9,641.83
--- - Outstanding Receivable Total $0.00 -
Current Billing Period Activity
Current Charges $9,622.09
Please Pay This Amount $9,622.09
Submitted To
1 31 Days,= 32--6 1 1.Days, 62 r91 Days >92,Ds
$9;622.09` ,$0:00 _ $0.00 $0.00,='
OCT 12 2016
reasurer
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
•
•n
1 This billing statement Page 1 VS
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. 6 Messages regarding
Payment Due Date: Upon receipt of this statement
displayed here. your payment,billing
statement,or
Sample Bill membership,if any.
Employee Benefits Department 2 Prior Billing Period Activity $57.00
2 Amount billed on the 1234 Quality Circle Amount Previously Billed -$40.00
last billing statement. Anywhere,CA 98560-4855 3 Payments/Billing Adjusments -$5.00
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. 0-31 Days 32-61 Days 62-91 Days >92 days-
5 1 $52.00 $5.00 $7.00 $0.00 8 Please complete and
return the payment
coupon to the VSP
4 Total charges for this address on the
billing cycle. 6 VSP appreciates your business.
bottom of the billing
statement.
9 Total charge/amount due
rJ Outstanding receivable 7 for this billing cycle.
detail section. Passion for People.Vision for Lite.
.......................................................................................................................................
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
9 Amount Due $64.00
$ Return To:
VSP-(CA) mount Paid $
P.O.Box 45210
San Francisco,CA 94145-5210 10 Number Paid for