188683 08/17/2010 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
ONE CIVIC SQUARE HYLANT GROUP
CARMEL, INDIANA 46032 P o BOX 40925 CHECK AMOUNT: $25,193.00
INDIANAPOLIS IN 46082 -4910
CHECK NUMBER: 188683
CHECK DATE: 8/17/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
302 5023990 73454 25,193.00 OTHER EXPENSES
EffyDate Trn TYPe r aPolicy s a Description "f E Amount `a
"-i°° g* t. e w �a _t f,. N r•. :a s� ,r
INVOICE 9 734454
01/01/09 R1S WC -S WCX002730 WORK COMP 4 OF 4 Citizens Ins Co or America S 14,0
01/01/09 RIS WC -S WCX002730 TVA 4 OF 4 Citizens Ins Co of America S 11,137,00
Invoice Balance: S 2 5,193.00
AUG 16 20110
By
H'YLANT G ROUP www.hylant.com
301 Pennsylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, IN 46280 0925 Local: 31.7 817 5000 Fax: 317 817 5151
VOUCHER NO. WARRANT NO.
ALLOWED 20
Hylant Group
iN SUM OF
301 Pennsylvania Parkway, Suite 201
Indianapolis, IN 46280 -0925
$25,193.00
ON ACCOUNT OF APPROPRIATION FOR
6I -rmi+t js#- l
1/kjco 2iC �YL GU 4A P. RtilJb jC z
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
—r
x-26 73454 I 43 -475.00 I $25,193.00 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
Monday, August 16, 2010
Director, Administration
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))
08/01/10 73454 $25,193.00
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