HomeMy WebLinkAbout327613 07/18/18 CITY OF CARMEL, INDIANA VENDOR: 00353199
CHECK AMOUNT: $*******400.00*
(9,
ONE CIVIC SQUARE ERNIE MAROONCARMEL, INDIANA 46032 1004 RETFORD DR CHECK NUMBER: 327613
WESTFIELD IN 46074 CHECK DATE: 07/18/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 07.10.18 400.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 00353199 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ERNIE MAROON IN SUM OF$ CITY OF CARMEL
1004 RETFORD DR 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.
WESTFIELD, IN 46074
Payee
$400.00
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
07.10.18 50-239.90 $400.00 1 hereby certify that the attached invoice(s),or 7/10/18 07.10.18 Bi-Annual Health Savings Account $400.00
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
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.
Clerk-Treasurer: Please return check to Human Resources for distribution.
Plan Participant/Payee:
Ernest Maroon
1520 N. Starr Road PLEASE CHANGE ADDRESS
Apache Junction,AZ 85119
Amount: $400.00
Fund: Medical Escrow Fund (301)
Date: July 10,2018
FSued TO