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Home My WebLink About187324 07/07/2010 CITY OF CARMEL, INDIANA VENDOR: 364393 Page 1 of 1 ONE CIVIC SQUARE HEALTH LIFE SCREENING LLC CHECK AMOUNT: $4,405.00 CARMEL, INDIANA 46032 3517 EMBASSY PARKWAY AKRON OH 44333 CHECK NUMBER: 187324 CHECK DATE: 7/7/2010 DE PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4341980 824 3,085.00 WELLNESS PROGRAM 1201 4341980 825 1,320.00 WELLNESS PROGRAM ti- Healthy Life Screening, LLC. Invoice 3517 Embassy Parkway Date Invoice Akron, OH 44333 6/10/2010 824 Bill To Ship To City of Carmel Healthy Life Screening One Civic Square 3517 Embassy Parkway Carmel, IN 46032 Akron, 01-1 44333 Attn: Sue Coy Attn: A.R. 1- 866 -523 -5433 P.O. Number Terms Rep Ship Via F.O.B. Project NM 6/10/2010 Quantity Item Code Description Price Each Amount 54 FPP Pull Prevention Package 165.00 8,910.00 Comp Comp -1 165.00 165.00 Cash payment Cash Chccks -4 465.00 465.00 CC- Paymcnt Credit card -50 5,195.00 5,195.00 Total $3,085.00 VOUCHER NO. WARRANT NO. ALLOWED 20 Heal Life Screening, LLC IN SUM OF 3517 Embassy Parkway Akron, OH 44333 $3,085.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO Dept, INVOICE NO. ACCT #!TITLE AMOUNT Board Members 824 43- 419.80 $3,085.00 1 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 Thursday, July 01, 2010 01- Director, HR Z Title claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1P. 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)) 06/10/10 824 $3,085.00 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 INDIANA RETAIL TAX EXEMPT PAGE C i ty CCERTIFICATE NO.003120155 002 0 o JL PURCH ASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 35- 60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE. FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. 4 DESCRIPTION VENDOR �LW a SHIP 3 5 �t TO CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION a Send Invoice To: PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT T PROJECT PROJECT ACCOUNT AMOUNT PAYMENT L L os' O 0 A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FO HE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY SHIPPING LABELS. f 4 THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE o AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 21 686 CLERK TREASURER --DOCUMENT CONTROL NO. VENDOR COPY Jul 02 10 10:23a Healthtj Life Sreening 1- 866 877 --0299 p.2 Healthy Life Screening, LLC. Invoice 3517 Embassy Parkway Date invoice Akron, 01-144333 6/11/2010 x25 Bill To Ship To Pity O'Carincl Healthy I.ili: screening ()roe Ovic Stluirre 3517 Ernbussy Parkway Carmel. IN 46032 Akron, 01-144333 Aiur; tiuc Coy Attn: A. R, 1 -966 -523 -5433 P,O. Number Terms Rep Ship Via F.O.B. Project NM 6 /11/20[0 Quantity Item Code Description Price Each Amount 33 Full Prt'vcntion Package 165.00 5.445.00 l 11'I' Full Prtwonlion Package -Tom lianify 175.00 175.00 ('nmp Comp -Tom Hunily 175.00 175.00 Cash payment Cush Checks -8 070,00 1,070.00 C(Alayment Credit turd -26 3,055.00 3,055.00 Total 1,320.00 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. r Payee Y"_ Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total 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 VGAJCHER NO. WARRANT NO. j ALLOWED 20 IN SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or Q I Q� 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 j r t 20 y Signa re P Cost distribution ledger classification if Title claim paid motor vehicle highway fund