314037 07/26/17 9��'`"� CITY OF CARMEL, INDIANA VENDOR: 369140
O ONE CIVIC SQUARE JANICE DAVIS CHECK AMOUNT: $......*300.00"
:?� q CARMEL, INDIANA 46032 14846 VICTORY COURT CHECK NUMBER: 314037
� CARMEL IN 46032 CHECK DATE: 07/26/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 07.24 .17 300.00 OTHER EXPENSES
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City of Carmel Employee Health Benefit Plan
Health Savings Account Incentive
The retired plan participant listed below has elected Plan A for 2017 and is eligible for a bi-
annual contribution to his or her HSA account, as authorized by Resolution BPW-10-03-12-02.
Payroll: Please return check to Human Resources for distribution.
Plan Participant/Payee:
Janice Davis
14846 Victory Court
Carmel, IN 46032
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: July 24,2017
Subm �ted To
JUL 2 5 2017
Clerk Treasurer