308291 02/13/17 u'a4q+, CITY OF CARMEL, INDIANA VENDOR: 370302
® z:I ONE CIVIC SQUARE VISION SERVICE PLAN CHECK AMOUNT: $*****9,897.72*
:, _�; CARMEL, INDIANA 46032 PO BOX 742788 CHECK NUMBER: 308291
9,,,T�N�,� LOS ANGELES CA 90074-2788 CHECK DATE: 02/13/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 02.01.17 9,897.72 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 370302 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
VISION SERVICE PLAN IN SUM OF$ CITY OF CARMEL
PO BOX 742788 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
LOS ANGELES, CA 90074-2788
Payee
$9,897.72
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
301 Medical Fund Terms
301 Medical Fund Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
02.01.17 50-239.90 $9,897.72 1 hereby certify that the attached invoice(s),or 2/1/17 02.01.17 Feb 2017 $9,897.72
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, February 08,2017
Lamb, Barbara
Director
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
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Account Number: 12 013661 0001 VS
Bill Print Date: FEBRUARY 01, 2017 For FEBRUARY 2017 e
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 $9,897.72
Payments/Billing Adjustments $0.00
— --- - --- - Outstanding Receivable Total--
Current Billing Billing Period Activity
Current Charges $9,877.55
Please Pay This Amount $19,775.27
1 -31 Days 32-61 Days 62-91 Days >92 Days
$19,775:27 $0.00 $0.00 $0.00
Questions? Please call 1-866-213-2249 if you have questions regarding your bill or membership.
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