182093 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
t Qk ONE CIVIC SQUARE ST VINCENT HOSPITAL
)o CARMEL, INDIANA 46032 EAP CHECK AMOUNT: $2,845.50
i 8401 HARCOURT ROAD CHECK NUMBER: 182093
*....00 INDIANAPOLIS IN 46260
CHECK DATE: 2/3 /2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 053973826 2,845.50 GENERAL INSURANCE
e �Y
ST VINCENT EMPL. ASST. PROGRAM
8401 HARCOURT RD
INDIANAPOLIS IN 46260 Date Account Number Balance
01/14/10 5- 20376299 2787.75
*CITY OF CARMEL
LAMB, BARB
CITY HALL 1 CIVIC SQUARE
CARMEL,IN 46032
Please enclose top portion with payment
Rate: 1.75 Number of Employees:
ACCT 5- 20376299 PATIENT: *CITY OF CARMEL CHG AMT PAY /ADJ BALANCE
INVOICE 053973826
EMP PROVIDER
01/11/10 JANUARY 2010 929-2 9q8.5
01/11/10 FEBRUARY 2010 92-9 y-g 50
01/11/10 MARCH 2010 9 -29-2-5 y s --p
INVOICE BALANCE:
olgLs :S
of■JQ Sq ��5 .%Cc1fti -ESL_
z3s
FEB 0 1 2010
Account 0 -30 days 31 -60 days 61 -90 days >90 days Balance Due
5- 20376299 2707.75 0.00 0.00 0.00 2707.7.5
PAGE: 1
ST VINCENT EMPL. ASST. M F 9a.m. to 4p.m.
8401 HARCOURT RD Ph: 317 338 -4900
INDIANAPOLIS IN 46260
n
VOUCHER NO. WARRANT NO.
L ALLOWED 20
St. Vincent Employee Assistance Program
IN SUM OF
8401 Harcourt Rd
Indianapolis, IN 46260
$2,845.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1205 053973826 43- 475.00 $2,845.50 I hereby certify that the attached invoice(s), or
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
h
.7 Thursday, January 28, 2010
dr
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01/14/10 053973826 Jan Feb Mar EAP Billing $2,845.50
f 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