319676 12/15/17 u•.C4N*I .
+` f• . CITY OF CARMEL, INDIANA VENDOR: 00350735
ONE CIVIC SQUARE BOB VANVOORST CHECK AMOUNT: $*******196.25*
CARMEL, INDIANA 46032 23402 MULE BARN ROAD CHECK NUMBER: 319676
SHERIDAN IN 46069 CHECK DATE: 12/15/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 12 .13 .17 . 196.25 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 00350735
BOB VANVOORST IN SUM OF$ CITY OF CARMEL
23402 MULE BARN ROAD 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.
SHERIDAN, IN 46069
Payee
$196.25
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
12.13.17 50-239.90 $196.25 1 hereby certify that the attached invoice(s),or 12/13/17 12.13.17 Reimburse December Medical Premiums $196.25
301 301 301 301 (Premium Holiday)
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
Thursday, December 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
INVOICE
The Board of Public Works and Safety has approved a premium holiday for December 2017.
Please process refunds from the Medical Escrow Fund(301) for the following retirees, whose
monthly contributions will be automatically deducted from their PERF pension checks.
These retirees should already be in the claims system except for Viehe, Whitaker and Young.
Brad Bartrom $235.50
Mark Callahan $196.25
Barry Crane $1,765.00
Leland Goodman $235.50
Timoth Green $886.00
Stephen Reeves $886.00
Frank Vallone $886.00
Robert VanVoorst $196.25
Richard Viehe $429.11
2374 W State Rd 234
Fortville, IN 46040
Charles Whitaker $246.51
308 W Haydn Dr
Apt 1318
Carmel, IN 46032
Alan Young $264.77
8772 Pine Acres Dr
Kalamazoo, MI 49009
LQ
DEC 1 3 2017
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