319558 12/12/17 o� """'f•': CITY OF CARMEL, INDIANA VENDOR: 370302,,..
(; z, ONE CIVIC SQUARE VISION SERVICE PLAN CHECK AMOUNT: $****10,318.36*
_ CARMEL, INDIANA 46032 PO BOX 742788 CHECK NUMBER: 319558
.9M. _. LOS ANGELES CA 90074-2788 CHECK DATE: 12/12/17 -
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 120117 10,318.36 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 370302 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
VISION SERVICE PLAN IN SUM OF$ 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
$10,318.36
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
12.01.17 50-239.90 $10,318.36 1 hereby certify that the attached invoice(s),or 12/1/17 12.01.17 Dec 2017 $10,318.36
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, December 12,2017
G
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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Page 1
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Account Number: 12 013661 0001 VS
Bill Print Date: DECEMBER 01, 2017 For DECEMBER 2017 a
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 $10,234.07
Payments/Billing Adjustments -$10,234.07
— --- — ---- — —-- -- - - -- ---- Outstanding Receivable Total
Current Billing Period Activity
Current Charges $10,318.36
Please Pay This Amount $10,318.36
................ ....
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SubmIfted To
DEC 12 2017
C Treasurer
Questions? Please call 1-866-213-2249 if you have questions regarding your bill or membership.
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