HomeMy WebLinkAbout187664 07/20/2010 CITY OF CARMEL, INDIANA VENDOR: L2347 Page 1 of 1
ONE CIVIC SQUARE UNUM LIFE INSURANCE CO OF AMERIC &ECK AMOUNT: $4.78
CARMEL, INDIANA 46032 PO BOX 406990
ATLANTA GA 30384 -6990
CHECK NUMBER: 187664
CHECK DATE: 7/20/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 1 4.78 LINDSAY WILLARD
Spelbring, James P HR
From: Coy, Sue E
Sent: Thursday, July 15, 2010 9:49 AM
To: Spelbring, James P HR
Subject: Lindsay Willard LTD Premium
Jim,
Could you please submit claim against the medical insurance for $4.78 for Lindsay's LTD premium? She submitted her
premium by check; however, it was inadvertently deposited by the Clerk's office.
The check needs to be made out to UNUM Provident and given to me. Thanks.
Sue Coy
Employee Benefits Administrator
Department of Human Resources
City of Carmel
317.571.5850 (Plx)
317.571.2409 (Fx)
D
JUL 19 2010
By
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j DONA IMPSON 740 936
j 9137 TIMPANI WAY 740292438
I J INDIANAPOLIS, IN 46231- 1. LA
DATE
I PAY TO THE 4
ORDER OF l �Y l Y: ;'C I y CLII G K)• �QQ
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MEMO �Q( �Y L
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C 11I LINDSAY M. WOMSOLD- WILLARD 08 -06 7 0 376 475
a� u 7345 BRITTANY WAY 112688073
FISHERS, IN 46038
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PAY TO THE
1 7 lXS/l, l ORDER OF l�- F T�
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!.1 LINDSAY M. WOMBOLD- WILLARD 08-06 740 4
I U 1 7345 BRITTANY WAY 1126114473
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ORDER OF y
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MEMO
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
UNUM Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10113195 71510 Lindsay Willard LTD Premiun $4.78
Total $4.78
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 NO. 10/13/95 WARRANT NO.
U N UM ALLOWED 20
IN SUM OF
$4.75
ON ACCOUNT OF APPROPRIATION FOR
301 Medical F und
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
QEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
71510 301 $4.78 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signature
Title
Cost distribution ledger classification If
claim paid motor vehicle highway fund