HomeMy WebLinkAbout327608 07/18/18 y CITY OF CARMEL, INDIANA VENDOR: 109200
z ONE CIVIC SQUARE LELAND C GOODMAN CHECK AMOUNT: $*******300.00*
s a CARMEL, INDIANA 46032 2150 E 950 S CHECK NUMBER: 327608
+��TON�°'� FLATROCK IN 47234 CHECK DATE: 07/18/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 07.10.18 300.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Hoard of Accounts City Form No.201(Rev.1995)
Vendor# 109200 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
LELAND C GOODMAN IN SUM OF$ CITY OF CARMEL
2150 E 950 S An invoice or bill to be property 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
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
07.10.18 50-239.90 $300.00 1 hereby certify that the attached invoice(s),or 7/10/18 07.10.18 Bi-Annual Health Savings Account $300.00
301 301 301 301 Contribution
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,July 12,2018
G
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
20Cost 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.
Clerk-Treasurer: Please return check to Human Resources for distribution.
Plan Participant/Payee:
Leland Goodman
2150 E 950 S
Flatrock, IN 47234
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: July 10,2018
S Submilitted To
JUL 11 2018
(33erk Treasurer