188751 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: L2367 Page 1 of 1
ONE CIVIC SQUARE CARMEL CLAY PARKS -MONON CENTER
CARMEL, INDIANA 46032 C/O AUDREY KOSTRZEWA CHECK AMOUNT: $263.94
CHECK NUMBER: 188751
CHECK DATE: 8118/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 19344 2010 -115 263.94 WELLNESS PROGRAM
Uarmel 0 clay Invoice
Parks &Recreation Date Invoice
1411 E 116th Street 8/11/2010 2010 -115
Carmel, IN 46032
Bill To
City of Carmel
One Civic Square
Carmel, IN 46032
Quantity Description Rate Amount
44 Adult Pass (City of Carmel) 12.93 568.92
3 Youth or Senior Pass (City of Carmel) 8.50 25.50
35 Household Pass (City of Carmel) 35.08' 1,227.80
LI
D
�,J. 16 2010
By
Remit to:
Carmel Clay Parks Recreation Total Due 1,822.22
1411 E. 116th St.
Carmel, IN 46032
Questions? 317- 573 -4025 Payment due 30 days from invoice date.
corppass @carmelclayparks.com Please return one copy with payment.
Name Payroll Membership Employee City Total Due
Alvey, Rick 7/212010 Household 30.00 5.08 35.08 Alvey 1Rick Household I $35.08 0.00
Blanchard, Jim 16/812007 Household 30.00 5.08 35.08 I Blanchard IJames I Household 1 $35.08 1
Brant, Kenneth 2112/2010 Household 30.00 5.08 35.08 1 Brant (Kenneth I Household 1 $35.118
Bucksot, William B. 7130!2010 Adult/Adult 22.16 3.70 25.86 Bucksot (William 1 Adult, Adult 1 $25.86
Buhmann, Kevin 7/612007 Household 30.00 5.08 35.08 iBuhmann (Kevin I Household $35.08
Burke, Raphael 1 5/26/2010 Household 30.00 [5.08 135.08 lBurke IRaphael Household 1 $35.08
Campbell, R. Scott 16/ 812007 Household 30.00 5.08 135.08 ICampbell IR. Scott I Household 1 $35.08
Carter, Ron 4 1112008 Senior /Adult 118.00 1 3.43 121.43 Carter IRon SeniorlAdult $21.43
Cooper, Jeffery 1 61412 0 10 Household 30.00 5.08 135.08 Collins Larry Household 1 $35.08
Collins, Larry 11 /212009 Household 130.00 15.08 135.08 Cooper Jeffrey Household $35.08
Cox, Justin 10'19!2009 Adult 1 11.08 11.85 112.93 Cox Justin Adult $12.93
Coy, Sue 6/8/2007 Household 30.00 15.08 135.08 1_ICoy 1Susan I Household $35.08
Daley, Penny 519!2008 Household 30.00 1 5.08 135.08 Taley Penny Household $35.08
Deitsch, Marc 21121201 Household 30.00 5.08 135.08 _I Deitsch Marc Household 1 $35.08
Dietz, Aaron 161619009 Household 30.00 5 1 Dietz Aaron Household 1 $35.08 I
Drake, Carl 5/9/2008 Adult 11.08 1185 112.93 I Drake Carl Adult 1 $12.93
Duffy, John 2!12!2010 Household 30.00 5.08 135.08 1 Duffy John Household 1 $35.08
Edwards, Dan 3/14/2008 Household 30.00 5.08 35.08 I Edwards Dan Household $35.08
Edwards, Steve 12/12/2010 Adult 30.00 5.08 j 35.08 I Edwards Steven Household $35.08
Essex, Co ry 12/26/2010 Adult/Adult 22.16 3.70 25.86 1 Essex Cory Adult, Ault $25.86
Fagin, Timoth 7/6/2007 Household 30.00 5.08 135.08 Fagin Timoth Household $35.06
Force, Jason 5/712010 (Household 130.00 5.08 1 35.08 I 1 Force Jason I Household $35.08 1
Gilbert, William 311412008 lAdult 11.08 11.85 112.93 1 IGilbert William Adult $12.93
Griffin, Tim 911412007 IHousehold 30.00 1 5.08 1 35.08 I (Griffin (Tim Household $35.08
Griffiths, Pam 6/8/2007 1Household 30.00 5.08 135.08 IGriffiths Pamela Household $35.08 I -1
Grimes, Jeff 18 19/2010 lAdult 11.08 11.85 12.93 (Grimes iJeff Adult $12.93 I
Hicks, Jeffrey 1 11212009 lAdult/Adult 22.16 3.70 25.86 11-licks iJeff Adult, Adult $25.86 1
Hollander, Greg 2/12/2010 Household 22.16 3.70 25.86 1Hollander (Greg Adult, Adult $25.86 I
Hollibaugh, Michael 17/6/2007 Household 30.00 5.08 135.08 1Hollibaugh (Michael Household $35.08 I
Hughes, Deborah 1/1/2009 Household 30.00 15.08 135.08 lHughes Deborah Household $35.08 1
Krcmery, Michelle 7/6/2007 Household 30.00 15.08 135.08 1Krcmery Michelle Household 1 $35.08 I
Lafollette, Gary 1 6/8/2007 AduIt/Adult 22.16 1 3.70 25.86 LaFollette Gary Adult, Adult $25.86 I
Lamb, Barb 111912067 Adult/Adult 22.16 3.70 25.86 1 (Lamb Barbara Adult/ Adult $25.86 1 I
Locke, Robert 618/2007 1 Household 30.110 15.08 35.08 Locke Robert Household $35.08 I
Luper, Michael [371412008 Adult 11.08 1.85 12.93 1Luper11 IMichael Adult $12.93 I
Martin, Candy 13/112009 Adult 11.08 1.85 J12 .93 Martin Candy Adult I $12.93 1 1
Martin, Richard 1672112010 Household 30.00 5.08 35.08 IMartin Richard Household $35.08 1 1
Mascari, John 10/12/2007 Adult 11.08 1.85 12.93 1 IMascari John Adult $12.93 I 1
Massin Rand 19/12/2008 Adult 11.08 1.85 12.93 IMassingill Randy Adult $12.93 I 1
Mast, Darren 71612007 Adult 11.08 1.85 12.93 IMasl Darren Adult $12.93
McNab, John 1/212009 Adult 11.08 1.85 1 12.93 McNab John Adult $12.93 1
Meyer, Amanda 6/812007 Adult/Adult 22.16 3.70 1 25.86 1 Meyer Amanda Adult, Adult $25.86 I_�
Miller, Adam 7/6/2007 Adult/Youth 18.00 3.43 1 -43 1 (Miller Adam Adult/Youth $21.43
Miller, Ken 4/23/2010 Senior/Adult 18.00 3.43 121 -43 (Miller Ken Senior/Adult J $21.43
Mor Trent 1/15/2010 (Adult 11.08 1.85 12.93 1 Morgan (Trent Adult 1 $12.93 I
My ers, Brad 1 211 120 0 8 (Household 30.00 5.08 135.08 1 Myers Brady Household I $35.08
Neville, Katie 1/15/2010 Adult 11.08 11.85 112.93 1 Neville lKatie I Adult $12.93 1
Nicely, Wes 11 V512008 lAdult 11.08 11.85 112.93 Nicley Wes I Adult $12.93
Orang Dou 10110(2008 lAdult 11.08 11.85 112.93 Oran Doug Adult $12.93
Paddock, Ronald 5/26/2010 Adult 11.08 11.85 112.93 Paddock lRonald Adult $12.93
Pattyn, Dawn 6/8/2007 Household 30.00 5.08 135.08 Patty (Dawn Household $35.08 I
Pitman, Michael 12112/2010 Household 130.00 15,08 1 35.08 1 Pitman IMcchael I Household 1 $35.08
Platt, Jace 6/8/2007 Adult 111.08 1 1.85 112.93 Platt 1Jace I Adult 1 $12.93 I
Price, Joe 1 211 812 0 0 9 Household 130.00 15.08 135.08 Price (Jose Household $35.08 I 1
Reynolds, Shawn 1612812010 Household 1 30.00 15.08 135.08 Rey nolds IShawn Household 1 $35.08 1 1
Rhodes, Kenneth 6/812007 AdultlAduIt 22.16 3.70 125.86 (Rhodes Kenneth Adult, Adult 1 $25.86 1
Rider, Kevin 12/1/2008 Adult/Adult 122.16 3.70 125.86 L_I Rider (Kevin Adult, Adult $25.86 1
Schriner, Adam 1112!2009 AdulUAdult 22.16 3.70 25.86 ISchriner lAdam Adult, Adult 1 $25.86
Sharp, Rick 10!10!2008 1Household 30.00 5.08 35.08 Shar p Rick Household $35.08
Smith, Jerry 21112008 �Household 30.00 5.68 135.08 Landry Household 1 $35.08 I
Smile Land 1/15/2010 (Household 1 30.00 5.08 35.08 1Smith Jerry Household I $35.08 1
Steury Kent 311/2009 Adult 1 11.08 1.85 112.93 1 Steu Kent Adult $12.93
Thomas, John 7/3/2008 1Adult/Adull 122.16 3.7 125.86 1 1 homas John I Adult, Adult $25.86
Tierne Scott 6/8/2007 Household 130.00 15.08 35.08 I�Tierney Scott I Household I $35.08
Utzi Chad 6/8/2007 Household 130.00 5.08 135.08 1_ Utzi g Chad I Household $35.08
Wen Ga 8/3/2010 Adult 1 11.08 11.85 112.93 I Wenger (Garry I Adult I $12.93
White. Robert 5/9/2008 Household 1 30.00 15.08 135.08 (White (Robert I Household $35.08
Whitlow, Sean 5/22/2009 Adult 111.08 11.85 1 12.93 J Whitlow (Sean 1 Adult 1 $12.93 1
I I I I Total Monthly Bill $1 ,822.22 1
I 1 1 I
1 11558.28 1263.94 11822.22 1 1 1 I I hI
VOUCHER NO. WARRANT NO.
ALLOWED 20
Carmel Clay Parks and Recreation Monon Ce
c/o Audrey Kostrzewa
IN SUM OF
1411 E. 116th St.
Carmel, IN 46032
$263.94
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. I ACCT #/TITLE AMOUNT Board Members
2010 -115 I 43- 419.80 I $263.94 1 hereby certify that the attached invoice(s), or
J
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
Director, HR
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
Date Number (or note attached invoice(s) or bill(s))
08/11/10 2010 -115 $263.94
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