HomeMy WebLinkAbout330783 10/09/18 (��,A,�f. CITY OF CARMEL, INDIANA VENDOR: 367222
® ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $11....**945.40*
9` ?�, CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 330783
�'�TON�° CHICAGO IL 60686-0020 CHECK DATE: 10/09/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 764146 945.40 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ CITY OF CARMEL
2046 RELIABLE PKWY 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.
CHICAGO, IL 60686-0020
Payee
$945.40
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
General Administration Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
764146 43-475.00 $945.40 1 hereby certify that the attached invoice(s),or 9/30/18 764146 EAP services Sept 2018 $945.40
1205 101 1205 101
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
Wednesday, October 3,2018
At__e cl.�
Crider,James
Administration
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
T2s
Indiana University Health Workplace Services,LLC
1 �a 714 N.Senate Avenue
Suite 200
Indianapolis, IN 46202
317-963-1535
Tax ID# 20-0994452
Invoice
September 30, 2018
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite EAP Services/Sept.2018
1 Civic Square
Carmel,IN 46032-
Invoice# 764146
Service Date Description Quanti Charge Recei Ad u-s Balance
09/01/2018 EAP Services 652.00 945.40 945.40
CITYCARO Invoice# 764146 Balance Due: 945.40
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
tl
lv
OCT 0 2 2018