HomeMy WebLinkAbout321584 02/13/18 CITY OF CARMEL, INDIANA VENDOR: 109200
r ONE CIVIC SQUARE LELAND C GOODMAN CHECK AMOUNT: $****-300.00'
*300.00*
CARMEL, INDIANA 46032 2150 E 950 S CHECK NUMBER: 321584
FLATROCK IN 47234 CHECK DATE: 02/13/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 02 .13 .18 300.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 109200 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
LELAND C GOODMAN IN SUM OF$ CITY OF CARMEL
2150 E 950 S 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.
FLATROCK, IN 47234
Payee
$300.00
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
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
02.13.18 50-239.90 $300.00 1 hereby certify that the attached invoice(s),or 2/13/18 02.13.18 2018 Health Savings Account $300.00
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 13,2018
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
City of Carmel Employee Health Benefit Plan
Health Savings Account Incentive
The retired plan participant listed below has elected Plan A for 2018 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:
Leland Goodman
2150 E 950 S UPDATED ADDRESS
Flatrock,IN 47234
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: February 13,2018
FEB 1 2018
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