HomeMy WebLinkAbout321594 2/13/2018 0]"l.
CITY OF CARMEL, INDIANA VENDOR: 0035301.6 CHECKAMOUNT: $*******300.00*
ONE CIVIC SQUARE BOB PELZERCARMEL, INDIANA 46032 14350 WEEPING WILLOW COURT CHECK NUMBER: 321594
CARMEL IN 46033 CHECK DATE: 02/13/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT_ DESCRIPTION
301 5023990 02.13 .18 300.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 00353016 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
BOB PELZER IN SUM OF$ CITY OF CARMEL
14350 WEEPING WILLOW COURT An invoice orb!]]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.
CARMEL, IN 46033
Payee
$300.00
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
021318 50-239.90 $300.00 1 hereby certify that the attached invoice(s),or 2/13/18 021318 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
/A,)"" 7c"_�
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:
Robert Pelzer
14350 Weeping Willow Court
Carmel,IN 46033
Amount: $300.00
Fund: Medical Escrow Fund(301)
Date: February 13,2018
SUbM,,ar tee, To �
FEB 13 2018
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