HomeMy WebLinkAbout321722 02/13/18 s f• ; CITY OF CARMEL, INDIANA VENDOR: 367222:
6 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $*******929.45*
CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 321722
v• r' CHICAGO IL 60686-0020 CHECK DATE: 02/13/18
EMIiUN G�'` ,
4 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 761645 929.45 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ CITY OF CARMEL
2046 RELIABLE PKWY 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.
CHICAGO, IL 60686-0020
Payee
$929.45
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
761645 43-475.00 $929.45 1 hereby certify that the attached invoice(s),or 1/31/18 761645 EAP Services Jan 2018 $929.45
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, February
06,2018
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
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Indiana University Health Workplace Services,LLC
714 N.Senate Avenue
12 Suite 200
Indianapolis, IN 46202
317-963-1535
Tax I D# 20-0994452
Invoice
January 31, 2018
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite EAP Services/Jan.2018
1 Civic Square
Carmel,IN 46032-
Invoice# 761645
Service Date Description Quanti Charge Receip Adjust Balance
01/01/2018 EAP Services 641.00 929.45 929.45
CITYCARO Invoice# 761645 Balance Due: 929.45
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
4 � 1 To
FEB 0 6 2018