308688 02/28/17 ,cAA
CITY OF CARMEL, INDIANA VENDOR: 371443
ONE CIVIC SQUARE VIRGIN PULSE, INC. CHECK AMOUNT: $****59,530.20*
;. =4 CARMEL, INDIANA 46032 DEPARTMENT 3310 CHECK NUMBER: 308688
PO BOX 123310 CHECK DATE: 02/28/17
lrori�O' DALLAS TX 75312-3310
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 INV61014 46,405.20 OTHER EXPENSES
301 5023990 INV61163 13,125.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 371443 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
VIRGIN PULSE, INC. IN SUM OF$ CITY OF CARMEL
DEPARTMENT 3310 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.
DALLAS, TX 75312-3310
Payee
$46,405.20
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
INV61014 50-239.90 $46,405.20 1 hereby certify that the attached invoice(s),or 2/1/17 INV61014 $46,405.20
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, February 21,2017
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
�1
Virgin Pulse
42 S9e Old Connecticut Path Invoice
- Framingham MA 01701 #I NV61014
United States 02/01/2017
Activity Month: Feb 2017
Sponsor PO# Memo Terms
Email Invoicingna virginpulse.com City of Carmel NET 30
Bill To Ship To
City of Carmel City of Carmel
Carmel City Hall Carmel City Hall
One Civic Square One Civic Square
Carmel IN 46032 Carmel IN 46032
United States United States
_---------
_---------
a i
Item Quantity Rate Amount
Annual Program Subscription Fee billing 606 $60.00 $36,360.00
Implementation Fee-Standard 1 $7,500.00 $7,500.00
Bank ACH Payment Instructions: Please Remit Checks To: Subtotal $43,860.00
Account Name:Virgin Pulse Inc. Virgin Pulse, Inc
Account Number:3300940047 Dept 3310 Tax $2,545.20
ABA Number: 121140399 PO Box 123310
Bank Name:Silicon Valley Bank Dallas,TX 75312-3310 Total $46,405.20
Bank Address:Santa Clara, CA 95054 s
Payments/Creditsv.____ $0.00
Amount Due $46,405.20
For any invoice past due beyond payment terms a finance charge of 1.5%per month or
18%per year may be added to the invoice.
Submitted To
FEB 21 2017
Clerk Treasurer
1 of 1
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 371443 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
VIRGIN PULSE, INC. IN SUM OF$ CITY OF CARMEL
DEPARTMENT 3310 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.
DALLAS, TX 75312-3310
Payee
$13,125.00
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
INV61163 50-239.90 $13,125.00 1 hereby certify that the attached invoice(s),or 2/15/17 INV61163 $13,125.00
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
Tuesday, February 21,2017
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
Virgin Pulse
492 Old Connecticut Path Invoice
Framingham
(jr—
el—
Ste 601 f �C� ham MA 01701
g #I NV61163
United States
02/15/2017
Activity Month: Feb 2017
Sponsor PO# Memo Terms
Email Invoicing(a)virginpulse.com City of Carmel NET 30
Bill To ShipTo
City of Carmel City of Carmel
Carmel City Hall Carmel City Hall
One Civic Square One Civic Square
Carmel IN 46032 Carmel IN 46032
United States United States
Item Quantity Rate Amount
Rewards Earned 1 $13,125.00
Bank ACH Payment Instructions: Please Remit Checks To: Subtotal $13,125.00
Account Name:Virgin Pulse Inc. Virgin Pulse, Inc
Account Number:3300940047 Dept 3310 Tax $0.00
ABA Number:121140399 PO Box 123310
Bank Name:Silicon Valley Bank Dallas,TX 75312-3310 Total $13,125.00
Bank Address:Santa Clara, CA 95054
L
Payments/Credits $0.00
Amount Due $13,125.00
For any invoice past due beyond payment terms a finance charge of 1.5%per month or
18%per year may be added to the invoice.
Submitted To
FEB 21 2017
Clerk Treasurer
101`1