HomeMy WebLinkAbout155152 01/08/2008 CITY OF CARMEL, INDIANA VENDOR: 359957 Page 1 of 1
ONE CIVIC SQUARE BLOCKOMS GOLF MANAGEMENT CO LLC
CARMEL, INDIANA 46032 7033 SEA OATS LANE CHECK AMOUNT: $1,203.29
INDIANAPOLIS IN 46250
re CHECK NUMBER: 155152
CHECK DATE: 118/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
905 4341999 1,203.29 OTHER PROFESSIONAL FE
I
i�
tif'AL1tER /S; ASSOCIATES INSURANCC
PO 13OX 19415 r December 3, 2007
INDIANAPOLIS, IN 46219 -0445 Page 1
sELE
Insurance
Phone No, 317 -353 -8000
BLOCKOMS GOLF MANAGEMENT CO LLC DBA BR
7033 SEA OATS LN
INDIANAPOLIS IN 46250 -4131
IIIIIII Illl V III III I I I IFI IIIEI I 111 I III II1111I Il1II11lI IIII IIII
I_.ACC
_®LINT 893 -876 -356 SUIMIARY
K
f
ave Time In Your Day,
BLOCKO
GOLF MANAGEMENT CO.
100
at 3�5
roe
Detach and retuin this portion with our a
Y p yment. Please write your account number on your check.
Name on Account Account Number
Account Balance Minimum Amt. Due Due Date Amount Enclosed
BLOCKOMS GOLF MAMA 893- 876 -356
3,622.00 9�
12j23/07 a
Make Check Payable To Selective Insurance Company of America
mail payment to:
Selective Insurance COmpanY of America
Box 371468
Pittsburgh- PA I5250 -7468 j
II Id, I IIIIII III IIIII 1 loll Il I.L. IIIII j11l Il III11I11
18938763561 2D2200700000916 00000036220000003
DB -40 (07806)
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ti 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
9to oko�_ts &OCR Co Purchase Order No.
V� Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01-o4-0% 6 e Zt k Ve, j Lk((A4A GE_ 60 45 d
Total
I 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. WARRANT NO.
ALLOWED 20
6Wc/ C01tilS
IN SUM OF
4t;l d
ON ACCOUNT OF APPROPRIATION FOR
WL qoS F
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
4341a�� 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
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
PAYCHEW CLIENT# D051 -5441 I 20071227
9405 DELEGATES.ROW.,
INDIANAPOLIS, IN 45240 TOTAL AMOUNT DUE
$113.74
AMOUNT ENCLOSED
PLEASE PAY TOTAL AMOUNT DUE BY 01110108
TO ENSURE PROPER CREDIT, PLEASE WRITE YOUR CLIENT.NUMBER
ADDRESS SERVICE REQUESTED ON YOUR CHECK AND RETURN THIS PORTION WITH YOUR PAYMENT.
0051 75441 PAYCHEX, INC.
BLOCKOMS GOLF MANAGEMENT PO BOX 4482
COMPANY LLC CAROL STREAM, IL 60197 -4482
12120 BROOKSHIRE PARKWAY
CARMEL IN 46033 111„ Illlitill IIIIIII All 1I1II11I„1I1illll,i
0051 ❑00000000000OOO5D4O401 2007122700 0000001137.4 4
1008
BLOCKOMS GOLF MANAGEMENT CO.
20-6
DATE Q i S 740 375
Po' 0/�� P To RD &ZOE l3
uv�r�ve� '�A DOS
National City
FOR oo5l 5 INN
Ki pill p�
^T
Prescribed by State Board of Accounts-, City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
a 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.
I' Payee
�lO�KoyAS 6vuFF wlf"4 Purchase Order No.
$�rook ye G C" Teims
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoices) or bill(s))
of -o3 Do �0 (A4PAMW 61WUIet Fee )13.74
Total 1 13-7
I 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. WARRANT NO.
ALLOWED 20
�l.cxko�.s C�c,� Vl,(� �e►Mel,� C
IN SUM OF
(�S oe Colo
ON ACCOUNT OF APPROPRIATION FOR
90 s-
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
43410il6i 113.1 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
20
Signature
113. Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
,00 m .INSURED COPY
Accident Fund
11VSt1RANCECOMPAWOFAMERICA Invoice Date 12/23/2007
PO BOX 77000 DEPT 77125
DETROIT MI 48277 -0125
Insured: Agent:
BLOCKOMS GOLF MANAGEMENT CO, WALKER ASSOCIATES INSURANCE
LLC PO BOX 19445
7033 SEA OATS LN INDIANAPOLIS IN 46219 -0445
INDIANAPOLIS IN 462504131
I, I, tLlittrtl tl111I ,II,t Jill ,ln111„III11,IIJ1111 I.It,11111tttl,f, IlItL,111t,1I „1,1,11,i,l,tltl,l
Policy Number: WCV 6033567 00 01 Telephone: 317- 353 -8000
Effective Date: 07121/20
Expiration Date: 07/2112008
101
BLOCKOMS GOLF MANAGEMENT CO.
24-6 375
DATE 1) 4 740
PAY TOTEM ORDM Of
hVy� U� k'In�y -mil h �g� OAAa
NatkMW City-
FOP,
gal
Totals $6,391.00 $3,840.80 $637.55
PAYMENT DUE 01/21/2008
PAYMENT MUST BE RECEIVED ON OR BEFORE DUE DATE TO AVOID CANCELLATION
DETACH ALONG THIS PERFORATION
TO ENSURE PROPER PAYMENT POSTING, PLEASE SEND REMITTANCE SLIP WITH PAYMENT
Thank you for your prompt payment.
Policy Number WCV 6033567 00 01 0015185
Effective Date: 07/21/2007
Amount Due Now: $637.55
Check Number
(Please write check number in the space provided)
Insured Please Remit Payment to:
BLOCKOMS GOLF MANAGEMENT CO- ACCIDENT FUND
LLC PO BOX 77000 DEPT 77125
7033 SEA OATS LN 0000001142 DETROIT MI 48277 -0125
INDIANAPOLIS IN 46250 -4131
Itl tl ll tt, I, IJ,I,lI,. „L,1,1111 „Il„1,IL11,I1 1, 11111 p ill III „,IIn,Ili,uutllnl,l,l,l „lrtll
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
5joc;ko AS LObF '�MW4c4 1 .0., Purchase Order No.
rJY�'I D k5 1 I re (-D(.F c�tM� Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
tAe
Total*
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. WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
C,VI,C 0 FUki a
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT,
DEPT. I hereby certify that the attached invoice(s), or
cat, 4 3�kla �t b 3 S C 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
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund