HomeMy WebLinkAbout331669 10/25/18 %���°';� CITY OF CARMEL, INDIANA VENDOR: 372863
ONE CIVIC SQUARE PROGRESSIVE INSURANCE CHECK AMOUNT: $*******623.66*
:oma ire CARMEL, INDIANA 46032 PO Box 512926 CHECK NUMBER: 331669
M��i6ti�O' LOS ANGELES CA 90051 CHECK DATE: 10/25/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 0 623.66 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor# 372863 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PROGRESSIVE INSURANCE IN SUM OF$ CITY OF CARMEL
PO BOX 512926 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.
LOS ANGELES, CA 90051
Payee
$623.66
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire 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
0 50-239.90 $623.66 1 hereby certify that the attached invoice(s),or 10/23/18 0 Refund of Overpayment $623.66
1120 102 1120 102
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
Tuesday, October 23,2018
David Haboush
Fire Chief
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
a ; ,
CIARNIJEL
October 23,2018
PROGRESSIVE INSURANCE
OVERPAYMENT DEPT
PO BOX 512926
LOS-ANGELES, CA 90051
RE : OVERPAYMENT RUN#2018-00003684 :1 DWAINE DAVIS
Date.of Service 10/17/2017
PROGRESSIVE MEDICAL PAYMENT:
Overpayment Refund $623.66 enclosed check.
Cigna health insurance paid$566.72.
Progressive Insurance in error paid the full amount$765.33 check112O22907887.
The amount due was only $14-1.67 coinsurance.
This created an overpayment of$623.66.
Refund to be sent to Progressive Insurance.
If you have any questions, please feel free to contact me at(317) 571-2604.
Sincerely,
Michelle T. Harrington
EMS Billing Administrator
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