308577 02/28/17 (9,
CITY OF CARMEL, INDIANA VENDOR: 367222ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: S"`**`*804.00`
CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 308577
CHICAGO IL 60686-0020 CHECK DATE: 02/28/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 754758 60.00 TESTING FEES
1205 4347500 754956 744.00 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ CITY OF CARMEL
2046 RELIABLE PKWY 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.
CHICAGO, IL 60686-0020
Payee
$60.00
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Human Resources 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
754758 43-588.00 $60.00 1 hereby certify that the attached invoice(s),or 1/31/17 754758 $60.00
1201 101 1201 101
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Tuesday, February 14,2017
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
,20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Indiana University Health Workplace Services, LLC
950 North Meridian Street
Suite 950 (City of Carmel)
X20 Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
January 31, 2017
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Occupational/Jan 2017
1 Civic Square
Carmel,IN 46032-
Invoice# 754758
Service Date DescriptionQuant! Charae Re ei Adjust Balance
--- --- ----------- - --- --- --. ..-_ .... ..
01/30/2017 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
INCLUDE
INVOICE#ON CHECK
Submitted To
FEB,13 2017
[--Clerk Treasurer
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ CITY OF CARMEL
2046 RELIABLE PKWY 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.
CHICAGO, IL 60686-0020
Payee
$744.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
General Administration 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
754956 43-475.00 $744.00 1 hereby certify that the attached invoice(s),or 1/31/17 754956 EAP services Jan 2017 $744.00
1205 101 1205 101
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, February 14,2017
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
Indiana University Health Workplace Services, LLC
1 .950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
Zoic 317-963-1535
Tax ID# 20-0994452
Invoice
January 31, 2017
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite EAP Services/Jan 2017
1 Civic Square
Carmel,IN 46032-
Invoice# 754956
Service Date Descriptio Quanti Charae Re ei Adjust B Ian
01/01/2017 EAP Services 620.00 744.00 744.00
CITYCARO Invoice# 754956 Balance Due: 744.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
SulbmittedTo
FEB J3 2017
Clerk Treasurer