HomeMy WebLinkAbout185349 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 360618 Page 1 of 1
ONE CIVIC SQUARE STEPHANIE MARSHALL
CARMEL, INDIANA 46032 578 TULIP POPPLUR CREST CHECK AMOUNT: $299.89
CARMEL IN 46033
CHECK NUMBER: 185349
CHECK DATE: 5/11/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4347500 40110 299.89 COBRA INS. HUSBAND
Richard Marshall, Jr. O SVP Worldwide COBRA Coupon #3 April /2010
Coverage Tier Period Premium
BCBS HDHP/HSA Medical/Dental Plan Employee Family 04/01/2010 04/30/2010 352.81
Comments Notes: Subtotal: $352.81
Amount Paid: $0.00
Return this Coupon and Your Payment to: Coverage for:
Total Due: S352.81
Medcom Richard Marshall, Jr. Due Date: 04/01/2010
P.O. Box 10269 Total Enclosed:
Jacksonville, FL 32247 -0269 578 Tulip Poplar Crest
Carmel, IN 46033 Make Check Payable to:
Medcom
Richard Marshall, Jr. SVP Worldwide COBRA Coupon #3 April /2010
Coverage Tier Period Premium
BOBS HDHP /HSA Medical/Dental Plan Employee Family 04/01/2010 04/30/2010 352.81
Comments Notes: Subtotal: $352.81
Amount Paid: $0.00
Return this Coupon and Your Payment to: Coverage for: Total Due: $352.81
Medcom Richard Marshall, Jr. Due Date: 04/01/2010
P.O. Box 10269 Total Enclosed:
Jacksonville, FL 32247 -0268 578 Tulip Poplar Crest
Carmel, IN 46033 Make Check Payable to:
Medcom
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e-mail: askus@hsabank.com
Para un representante en esparlol, por favor Ilamar at 866 357 -6232
Richard C Marshall Jr
578 Tulip Poplar Crest 1
Carmel, IN 46033 11 $1
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1 of 1 04101 -04130 11 $0.35
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$0.35 4 $604.90
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$4.27 $1,199.79
049(
Debits Credits Date Balance
BALANCE LAST STATEMENT 03/31/2010 1,
ANNUAL PERCENTAGE YIELD EARNED FOR 30 DAYS IS 0.30% Total For This T otal
i
INTEREST EARNED DURING CYCLE PERIOD 0.35 Period Year -to -Date fI
CURRENT INTEREST RATE 0.299/6 I Total Ov erdraft Fee s_ $0.00 I $0. I
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AVERAGE BALANCE FOR THIS STATEMENT CYCLE: $1,441.31 I
Total Returned Item Fees $0.00 I3 $0.00 h I
049(@BANKOVERDRAFT AND RETURNED ITEM FEE DISCLOSURE INFORMATION
g
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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))
Total �g
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 i
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
3 5�
POH or INVOICE NO. ACCT /TET AMOUNT
DEPT. I hereby certify that the attached invoice or
iOo3 255,21 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
20
U
iccLLnature
Director ofHedevelopment
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund