156452 02/20/2008 CITY OF CARMEL, INDIANA VENDOR: 359957 Page 1 of 1
ONE CIVIC SQUARE BLOCKOMS GOLF MANAGEMENT COL C
CARMEL, INDIANA 46032 7033 SEA OATS LANE HECK AMOUNT: $178.85
INDIANAPOLIS IN 46250
CHECK NUMBER: 156452
CHECK DATE: 2/20/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
905 4350900 178.85 ADP FEES
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CLEVELAND OH 44131
Invoice 345078
Cj February 1, 2008 Page 1
Accounts receivable number:
00034 740397
C008
PAUL BLOCKOMS
Any questions? Call your ADP BLOCKOMS GOLF MANAGEMENT
service representative, 12120 BROOKSHIRE PARKWAY
Focus Team (800)537 -1237 CARMEL IN 46033 -3314
Current Charges Autopay II Company code 63J
Processing Charges for period ending 01/31/2008
6 Pays 61.10
Check Signing at no charge
Labor Distribution 9.75
Total Tax at no charge
YTD Download at no charge
CheckView Processing Fee at no charge
For Payroll Delivery Only 8.00
24 Hr. Service at no charge
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BLOCKOMS GOLF MANAGEMENT CO.
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Return Stub BLOCKOMS GOLF MANAGEMENT Accounts receivable number: 00034 740397
J' Mail payment to: Product Company code: 1063J
Invoice number: 345078
Invoice date: 02/01/2008
Lockbox number: 03
0
ADP, INC.
Total due this invoice: $178.85 0
P.O BOX 78415 Payment due date: 02/08/2008
PHOENIX AZ 85062 -8415
Amount enclosed:
0030303407403970020108003450780000178858
WALKER ASSOCIATES INSURANCE February 2, 2008
PO BOX 19445;' v Page I
INDIANAPOLIS, IN 46219-0445 OA
SELECTIVE
w Insurance
Phone No. 317- 353 -8000
BLOCKOMS GOLF MANAGEMENT CO LLC DBA BR
7033 SEA OATS LN
INDIANAPOLIS IN 46250 -4131
ACCOUNT 893- 876 -356 SUMMARY
Save Time In Your Day,
Previous Amount Due 916.00 Use SelectPaylm
Payment Received Thank You 1,356.00
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BLOCKOMS GOLF MANAGEMENT CO. 1009
DATIE oZ 11 og 375
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Name on Account Account Number Account Balance Minimum Amt. Due Due Date Amount Enclosed
BLOCKOMS GOLF NIANA 893 876 -356 2,272.00 470.00 02/23/08
Make Check Payable To Selective Insurance Company of America Mail Payment to:
Selective Insurance Company of America
Box 371468
Pittsburgh PA 15250 -7468
1893876356020220080000047000000022720000005
DB- 40(07 /06) 00- 13090 -00000 893 876 -356'
PAYC9AVP CLIENT# 0051 -5441 INVOICE# 20080131
9405 DELEGATES ROW
INDIANAPOLIS, IN 46240 TOTAL AMOUNT DUE
$348.01
AMOUNT ENCLOSED
PLEASE PAY TOTAL AMOUNT DUE BY 02111108
TO ENSURE PROPER CREDIT, PLEASE WRITE YOUR CLIENT NUMBER
ADDRESS SERVICE REQUESTED ON YOUR CHECK AND RETURN THIS PORTION WITH YOUR PAYMENT.
0051 -5441 PAYCHEX, INC.
BLOCKOMS GOLF MANAGEMENT PO BOX 4482
COMPANY LLC CAROL STREAM, IL 60197 -4482
12120 BROOKSHIRE PARKWAY
CARMEL IN 46033
0051 0000000000000005040401 2008013100 00000034801 5
IF YOU HAVE QUESTIONS ABOUT YOUR ACCOUNT, PLEASE CALL (317) 815 -9300 PAGE 1 OF 1
CLIENT 0051 -5441 BLOCKOMS GOLF MANAGEMENT INVOICE DATE 01/31/08
BILLING PERIOD 12/28/07 TO 01/31/08 INVOICE 20080131
DATE DESCRIPTION SERVICES AMOUNT ACCOUNT SUMMARY
PREVIOUS BALANCE
12/27/07 INVOICE 20071227 DUE_ 01/10/08 113.7 TOTAL PREVIOUS BALANCE 113.74
PAYMENTS
01/14/08 RECEIVED THANK YOU -113.74 PAYMENTS 113.74
CHARGES 12/28/07 TO 01/31/08
01/12/08 6 PAYROLL /TAXPAY 55.71 PAST DUE AMOUNT 0.00
01/12/08 6 FLEXIBLE PAY PACKAGE 12.3
01/12/08 SPECIAL OFFER -27.20
49 W -2 PROCESSING /HANDLING 277.7 CURRENT CHARGES 348.01
1 DELIVERY 7.5(
QUARTER END /YEAR END DELIVERY 21.9
TOTAL AMOUNT DUE 348.01
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BLOCKOMS GOLF MANAGEMENT CO 1016
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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
359957 Purchase Order No.
Blockoms Golf Mgmt LLC
7033 Sea Oats Ln Terms
Indianapolis IN 46250 -4131 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
ZY I�
Total Z 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
359957 IN SUM OF
Blockoms Golf Mgmt LLC
7033 Sea Oats Ln
Indianapolis IN 46250 -4131
7 Jf-
ON ACCOUNT OF APPROPRIATION FOR
905 16
Board Members
PO# or DEPT. INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
3 ,Sb7 g materials or services itemized thereon for
which charge is made were ordered and
received except
v2 20 e)
l
S.gna re
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund