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332012 11/13/18 CITY OF CARMEL, INDIANA VENDOR: 109200 J ® t ONE CIVIC SQUARE LELAND C GOODMAN CHECK AMOUNT: $*******235.50* CARMEL, INDIANA 46032 2150 E 950 S CHECK NUMBER: 332012 FLATROCK IN 47234 CHECK DATE: 11/13/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 11.07.18 235.50 OTHER EXPENSES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 109200 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER LELAND C GOODMAN IN SUM OF$ CITY OF CARMEL 2150 E 950 S An invoice or bill to be 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. FLATROCK, IN 47234 Payee $235.50 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 11.07.18 50-239.90 $235.50 1 hereby certify that the attached invoice(s),or 11/7/18 11.07.18 Refund Premium Holiday for November and $235.50 301 301 301 301 December 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, November 13,2018 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 INVOICE On November-7; 2018, the Board of Public Works approved a.premium holiday for November and December 2018.- Please_process Novemberrefunds.from the Medical Escrow Fund(301) for the.following retirees,.whose monthly.contributions will be.deducted automatically from their PERF pension.checks.. lzlghtedaddresses mai not be in Ltge accounts a, able s, stem et Return all checks to Barb Lamb in Human Resources. Thankyou. Brad Bartrom $235-.50 P.O. Box 526,- Carmel, IN 46.082 Mark Callahan: $196.25 1108U Bast SSR 47, Sheridan,lN 4G06' Bgty Crane . $738.00 61©1 North Parker Auenue, Indianapolis, IN 4622:! Leland Goodman $235.50 2150 E 950 S, Flatrock,IN 47234 Timoth, Green $886:00 11468-Senie.Lane, Carmel-. IN 46032 David Mead $886.00 1511 Queensborough Drive, Carmel, IN 46033 Donald Mead $886.00 7992 Vista del Norte,Payson,AZ 85541 Stephen Reeves $886.00 580 Barbee Lane, Indianapolis, IN 46280 Frank Vallone $886.00 10707 Morristown Court- Carme146032. Robert VanVoorst $196.25 23402 Mule Barn Road, Sheridan,IN 4.6069 Richard Viehe $429.11 2374 W.. State Road 234,Fortville, IN 46040 Charles Whitaker -$246:51 308 W. Haydn Drive, Apt 1318, Carmel;IN 47032 Alan Young $26.4.77 42495 Es rit Drive, Carmel, i 4f07 NOV 133 2018