HomeMy WebLinkAbout194358 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
0 ONE CIVIC SQUARE T VINCENT HOSPITAL CHECK AMOUNT: $2,845.50
CARMEL, INDIANA 46032 SP
�c, a »gib 8401 HARCOURT ROAD CHECK NUMBER: 194358
INDIANAPOLIS IN 46260
CHECK DATE: 2/3/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 055233445 2,845.50 GENERAL INSURANCE
ST VINCENT EMPL. ASST. PROGRAM
8401 HARCOURT RD
INDIANAPOLIS IN 46260 Date Account Number Balance
01/13/11 5- 20376299 2845.50
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*CITY OF CARMEL.
LAMB,BARB
CITY HALL 1 CIVIC SQUARE
CARMEL,IN 46032
Please enclose top portion with payment
Rate: 1.75 Number of Employees: 542
ACCT 5- 20376299 PATIENT: *CITY OF CARMEL. CHG AMT PAY /ADJ BALANCE
INVOICE 055233445
EMP PROVIDER
O1 /11 /11 JANUARY 2011 948.50
01/11/11 FEBRUARY 2011 948.50
01 /11 /11 MARCH 2011 948.50
INVOICE BALANCE: 2845.50
Account 0 -30 days 31 -60 days 61 -90 days >90 days Balance Due
5- 20376299 2845.50 0.00 0.00 0.00 2845.50
PAGE: 1
ST VINCENT EMPL. ASST. M F 9a.m. to 4p.m.
8401 HARCOURT RD Ph: 317- 338 -4900
INDIANAPOLIS IN 46260
VOUCHER NO, WARRANT NO.
ALLOWED 20
St. Vincent Employee Assistance Program
IN SUM OF
8401 Harcourt Rd
Indianapolis, IN 46260
$2,845.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. ACCT #fTITLE AMOUNT Board Members
T
1205 I 055233445 I 43- 475.00 I $2,845.50 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, January 31, 2011
--2
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))
01/13/11 055233445 $2,845.50
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