181248 01/13/2010 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
ONE CIVIC SQUARE HYLANT GROUP
CHECK AMOUNT: $25,194.25
CARMEL INDIANA 46032 P 0 BOX 40925
off INDIANAPOLIS IN 46082 -4910 CHECK NUMBER: 181248
CHECK DATE: 1/13/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
302 5023990 714688 25,194.25 OTHER EXPENSES
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INVOICE 714688
01/01/09 RIS WC -S WCX002730 WORK COMP 1 OF 4 Citizens Ins Co of America 14,056.75
01/01/09 RIS WC -S WCX002730 1l'A 1 OF 4 Citizens Ins Co of America 11,137.50
Invoice Balance: 25,194.25
HYLANT GROUP www.hylant.com
301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 -0925 Local: 317-817-5000 Fax: 317- 817 -5151
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
Payee
Hylant Group Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01/06/10 714688 Quarterly Workers Compensation $25,194.25
Total $25,194.25
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
Clerk- Treasurer
VOUCHER NQ 11 1110 WARRANT NO.
ALLOWED 20
Hylant Group IN SUM OF
PO Box 40925
Indianapolis, IN 46280
$25,194.25
ON ACCOUNT OF APPROPRIATION FOR
302 Workers Compensation
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
714688 302 $25,194.25 materials or services itemized thereon for
which charge is made were ordered and
received except
7 20
Si nature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund