319945 12/21/2017 CITY OF CARMEL, INDIANA VENDOR: 003529,9.9
® ONE CIVIC SQUARE HYLANT`GROUP CHECK AMOUNT: 9*******364.00*
CARMEL, INDIANA 46032 PC 80x 638720 CHECK NUMBER: 319945
v CINCINNATI OH 45263-8720 CHECK DATE: 12/21/17
Mf TONI:�
DEPARTMENT ACCOUNT PO NUMBERINVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 167495 364.00 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 00352999 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
HYLANT GROUP IN SUM OF$ CITY OF CARMEL
PO BOX 638720 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.
CINCINNATI, OH 45263-8720
Payee
$364.00
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
167495 43-475.00 $364.00 1 hereby certify that the attached invoice(s),or 12/12/17 167495 $364.00
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, December 12,2017
A-ecl�. Q
Crider,James
Administration
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
Please Return Top with Remittance To: PO Box 638720, Cincinnati,OH 45263-8720
/item# Trans Eff Date Due Date Trans Description Amount
Business Auto Policy# 8103036P64A Effective: 1/1/17 - 1/1/18
Issuing Company Charter Oak Fire Insurance Co
1282001 5/25/2017 12/27/2017 ENDT Amend Composite Rate Exposures 364.00
Total Invoice Balance: $364.00
To
F DEC 12 2017
C!,
HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
12/12/2017 City of Carmel Loan# Invoice#167495 FARWE1 Page 1 of 1