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321915 02/13/18 4F. CITY OF CARMEL, INDIANA VENDOR: 370302 I; ONE CIVIC SQUARE VISION SERVICE PLAN CHECK AMOUNT: $****10,263.47* x ?� CARMEL, INDIANA 46032 PO BOX 742788 CHECK NUMBER: 321915 9y_roN LOS ANGELES CA 90074-2788 CHECK DATE: 02/13/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE_NUMBER AMOUNT DESCRIPTION 301 5023990 020118 10,263.47 OTHER EXPENSES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 370302 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER VISION SERVICE PLAN IN SUM OF$ CITY OF CARMEL PO BOX 742788 An invoice or bill to be properly itemized must show:kind of service,when;performed,dates service rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. LOS ANGELES, CA 90074-2788 Payee $10,263.47 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 02.01.18 50-239.90 $10,263.47 1 hereby certify that the attached invoice(s),or 2/1/18 02.01.18 Feb 2018 $10,263.47 301 301 301 301 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 Thursday, February 08,2018 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 Page 1 ® 1 • Account Number: 12 013661 0001 VS Bill Print Date: FEBRUARY 01, 2018 For FEBRUARY 2018 pe Membership Received After: The 15th of the month will reflect on your next bill. Payment Due Date: Upon receipt of this bill CITY OF CARMEL C/O BARBARA LAMB 1 CIVIC SQUARE CARMEL IN 46032-2584 Prior Billing Period Activity Amount Previously Billed $10,193.95 Payments/Billing Adjustments -$10,193.95 Outstanding Receivable Total $0.00 Current Billing Period Activity Current Charges $10,263.47 Please Pay This Amount $10,263.47 1 E.: .::Ys.;:..;3 ,.;.$:1.:13 : J.i. >.s. . 2©aYs;;>: . _ is 263 47 ........ ....... .......... FEB 0 7 2018 Questions? Please call 1-866-213-2249 if you have questions regarding your bill or membership. .=.��.: :<:::>::>::>::::>: FaS.carr.for. eo f.....�i�rr�n..fac.ttf ::_.<:.: >:><:>::::>::::>:: P.: :: .:.:::::::::::.:::::::::::