HomeMy WebLinkAbout198036 06/06/2011 }f CITY OF CARMEL, INDIANA VENDOR: 364990 Page 1 of I
4 ONE CIVIC SQUARE C H C WELLNESS
CARMEL, INDIANA 46032 5440 N CUMBERLAND AVE #225 CHECK AMOUNT: $4,410.00
oN CHICAGO a 60656 CHECK NUMBER: 198036
CHECK DATE: 6/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 21668 WL0470 3,675.00 WELLNESS PROGRAM
1125 R4341980 28028 WL0470 735.00 WELLNESS PROGRAM
5440 North Cumberland Avenue Invoice
Suite 225
Chicago, Illinois 60656 Date Invoice
5!12/2011 WL0470
REDEFINING HEALTH
Bill To Ship To
City of Carmel
Attn: Sue Coy
1 Civic Square
Carmel, IN, 46032
P.O. Number Terms Rep Ship Via F.O.B. Project
Net 30 Ron 5/12/2011
Quantity Item Code Description Price Each Amount
1 WLCSF Weight Loss Challenge Set -up Fee City Hall 350.00 350.00
1 WLCSF Weight Loss Challenge Set -up Fee Water 350.00 350.00
106 WLCPF Weight Loss Challenge Participant Fee 35.00 3,710.00
R
JUN 0 6 2011
BY—
O
.4
O
Thank you for your business.
T otal $4,41.0.00
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))
05/12/11 WL0470 $735.00
05/12/11 I WL0470 I I $3,675.00
I hereby certify that the attached invoice(s), or bill(s), is (are) 1rue 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
CHC Wellness
IN SUM OF
5440 North Cumberland Avenue, Suite 225
Chicago, IL 60656
$4,410.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. I ACCT /TITLE AMOUNT Board Members
43- 419.80 $735.00 f hereby certify that the attached invoice(s), or
21668 WL0470 43- 419.80 $3,675.00 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, .tune 06, 2011
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund