193046 12/22/2010 CITY OF CARMEL, INDIANA VENDOR: 364990 Page 1 of 1
ONE CIVIC SQUARE C H C WELLNESS
0 CARMEL, INDIANA 46032 CHECK AMOUNT: $750.00
5440 N CUMBERLAND AVE #225
CHICAGO IL 60656 CHECK NUMBER: 193046
CHECK DATE: 12/22/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 19344 750.00 WELLNESS PROGRAM
5440 North Cumberland Avenue Invoice
Suite 225
Chicago, Illinois 60656 Date Invoice
12/14/2010 12.14.01
'-.ACDLI I N I NG:NAAA I H:
Bill To Ship To
City of Carmel
Attn: Barbara Lamb
l Civic Square
Carmel, IN, 46032
P.O. Number Terms Rep Ship Via F.O.B. Project
Net 30 Ron 12/14/2010
Quantity Item Code Description Price Each Amount
5 HLTHWLLNSS Health and Wellness 150.00 750.00
Thank you for your business.
Total $750.00
VOUCHER NO. WARRANT NO.
CHC Wellness ALLOWED 20
IN SUM OF
5440 North Cumberland Avenue, Suite 225
Chicago, IL 60656
$750.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
19344 I 12.14.01 I 43- 419.80 I $750.00 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, December 20, 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))
12/14/10 I 12.14.01 I I $750.00
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