333418 12/14/18 4y of CAq��
.J® ,` CITY OF CARMEL, INDIANA VENDOR: 370302
ONE CIVIC SQUARE VISION SERVICE PLAN CHECK AMOUNT: $****10,236.79*
r. ?�: CARMEL, INDIANA 46032 PO Box 742788 CHECK NUMBER: 333418
9'7/,•,_�- LOS ANGELES CA 90074-2788 CHECK DATE: 12/14/18
f�pN CO
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 DEC18 10,236.79 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 370302 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
VISION SERVICE PLAN IN SUM OF$ CITY OF CARMEL
PO BOX 742788 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 90074-2788
Payee
$10,236.79
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
Dec 2018 50-239.90 $10,236.79 1 hereby certify that the attached invoice(s),or 12/11/18 Dec 2018 $10,236.79
301 301 301 301
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, December 12,2018
CA4--v c
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
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Page 1 J.;
® 1
Account Number: 12 013661 0001 VS
pe
Bill Print Date: DECEMBER 03, 2018 For DECEMBER 2018
Membership Received After: The 15th of the month will reflect on your next bill.
Payment Due Date: Upon receipt of this bill
CITY OF CARMEL C/O
BARBARA LAMB
1 CIVIC SQUARE
CARMEL IN 46032-2584
Prior Billing Period Activity
Amount Previously Billed $10,215.60
Payments/Billing Adjustments $0.00
Outs_tandi_ng Receiv_a4le-lotal �1D,2-i-5 60
Current Billing Period Activity
Current Charges $10,236.79
Please Pay This Amount $20,452.39
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Questions? Please call 1-866-213-2249 if you have questions regarding your bill or membership.
Passion forpeole I�ro�t forltfe $m