186251 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 362339 Page 1 of 1
ONE CIVIC SQUARE CITIZENS MANAGEMENT INC
CARMEL, INDIANA 46032 PO Box 620
CHECK AMOUNT: $1,198.42
HOWELL MI 48844 -0620
CHECK NUMBER: 186251
CHECK DATE: 6/9/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347000 SWC0000385 1,198.42 WORKMEN'S COMPENSATIO
t
Citizens
Management Inc-
a p- y "J71"11..o.P� f1w- fl(e(; "p Citizens Management Inc., PO Box 620, Howell, MI 48844 -0620 Loss Fund Invoice
TO:
MS. SHELLY M. LINGELBAUGH
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL, IN 46032
DATE: 05/28/2010
LOSS FUND INVOICE
REFERENCE swc00003s5 AMOUNT 'DUES.
INITIAL DEPOSIT $25,000.00
05/28/2010 BALANCE $23,801.58
AMOUNT DUE $1,198.42
IF YOU HAVE ANY QUESTIONS REGARDING THIS BILL PLEASE CONTACT US AT: 517 -540 -3186
PLEASE NOTE: WE ARE FORBIDDEN BY LAW TO ISSUE CHECKS SHOULD YOUR LOSS FUND BECOME ZERO BALANCE
Prescribed by State Board of Accounts City Form No. 201(Rev. 1995)
t 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
Citizens Management, Inc.
Purchase Order No.
r
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
05/28/10 SWC0000385 Loss Fund Invoice $1
Total $1,198.42
1 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 N C66m3iln kWARRANT NO.
ALLOWED 20
G;'itizens Management, Inc. IN SUM OF
PO Box 620
Howell, MI 48844 -0620
$1,198.42
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
Board Members
PO# or
DEPT. INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1205 SWC0000385 43 -470 $1,198.42 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Sigh toe
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund