HomeMy WebLinkAbout188679 08/17/2010 CITY OF CARMEL, INDIANA VENDOR: 362339 Page 1 of 1
ONE CIVIC SQUARE CITIZENS MANAGEMENT INC
CARMEL, INDIANA 46032 PO BOX 620
CHECK AMOUNT: $5,670.53
HOWELL MI 48844 -062D
CHECK NUMBER: 188679
CHECK DATE: 811712010
DEPARTMENT ACCOUNT P NUMBER INVOICE NUMBE AMOUNT DESCRIPTION
302 5023990 SWC0000385 5,670.53 WORKERS COMP
Citizens
Management Inc..
n „P-) q'n,er Citizens Management Inc., I PO Box 620, Howell, M1 48844 -0620 Loss Fund Invoice
TO: MS. SHELLY M. LINGELBAUGH
CITY OF CARMEL U
ONE CIVIC SQUARE AU IJ 1 6 2010
CARMEL, IN 46032
BY
DATE: 07/30/2010
LOSS FUND INVOICE
REFERENCE SWC0000385 AMOUNT DUE
INITIAL DEPOSIT $25,000.00
07/30/2010 BALANCE $19,329.47
AMOUNT DUE $5,670.53
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Citizens Management Inc.
IN SUM OF
PO Box 620
Howell, M1 48844 -0620
$5,670.53
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# 1 Dept. INVOICE NO. I ACCT #!TITLE AMOUNT Board Members
r
1205 I 073010 I 43- 475.00 I $5,670.53 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
Monday, August 16, 2010
1
Director, Administrati n
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
Da Number (or note attached invoice(s) or bill(s))
07/30/10 073010 $5,670.53
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
1 20
Clerk- Treasurer