HomeMy WebLinkAbout327621 07/18/18 +�r_CgA�
! ,� CITY OF CARMEL, INDIANA VENDOR: 00350917
ONE CIVIC SQUARE KIM ROTT CHECK AMOUNT: $*******400.00*
r �' CARMEL, INDIANA 46032 1303 HOLLYCREST DRIVE CHECK NUMBER: 327621
+;ETON� BLOOMINGTON IL 61701 CHECK DATE: 07/18/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 07.10.18 400.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 00350917 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
KIM ROTT IN SUM OF$ CITY OF CARMEL,
1303 HOLLYCREST DRIVE An invoice or bill to be pmpedy 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.
BLOOMINGTON, IL 61701
Payee
$400.00
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 $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
f�
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:
Kimberly Rott
1303 Hollycrest Drive
Bloomington,EL 61701
Amount: $400.00
Fund: Medical Escrow Fund (301)
Date: July 10,2018
cl m11tted To
JUL 11 2018
Clark. Treasurer