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HomeMy WebLinkAbout197233 05/11/2011 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1 ONE CIVIC SQUARE HYLANT GROUP CARMEL, INDIANA 46032 P 0 BOX 40925 CHECK AMOUNT: $646.00 INDIANAPOLIS IN 46082 -4910 CHECK NUMBER: 197233 CHECK DATE: 5/11/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER A MOUNT DESCRIPTION 302 5023990 758820 646.00 WC AUDIT prX'Tyt Indianap x 09IN 46280 -0925 a` Local: 317- 817 -5000 INVOICE 758820_ AAAGRouip CARME80 79 04/27/11 Cortxpe 5Satlon WCX002730 W. Michael Wells ��cn7.v�.: �oeu: -::-r- snbYlg�. ©r��•,4— :r_.•�:a: City of Carmel 01/01/09 01/01/12 04/27/11 o n yiatiNr:rgm� r _ctrur�c:_s Steve Engelking 646.00 One Civic Square Carmel, IN 46032 Wiz_- t__:'.r_= :�.r.:��._: r� -•--1• xrf S- �L�. -L �i...._ 5_."ty- S: -x i #f D to Trn J pSiic r__D�scrJto"r;• ==r V5 INVOICE 758820 01/01/09 AUD WC -S WCX002730 WC AUDIT Citizens Ins Co of America 646.00 WC FINAL AUDIT PERIOD: 1/1/10 -11 Invoice Balance: 646.00 D Q 0 MAY 0 9 2011 By 301Penusylvania Parkway Suite 201 P.O. Box 40925 Indianapolis, 1N 46280-0925 Toll Free: 800 678 -0361 Local: 317- 817 -5000 Fax: 317 -817 -5151 40 Ben Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 Hylant Group Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 04/27177 758820 WC Audit Adiustment 646.00 Total $646.00 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 VOUCHER NO. 04/27177 WARRANT NO. ALLOWED 20 Hylant Group IN SUM OF PO Box 40925 Indianapolis, IN 46280 -0925 $646.00 ON ACCOUNT OF APPROPRIATION FOR 302 Workers Compensation Board Members P0# or D PT. INVOICE NO, ACCT #ITITLE AMOUNT I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 758820 301 $646.00 materials or services itemized thereon for which charge is made were ordered and received except A AA 2 i' Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund