HomeMy WebLinkAbout179591 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 027850 Page 1 of 1
ONE CIVIC SQUARE JAMES BRAINARD
li CHECK AMOUNT: $370.20
CARMEL, INDIANA 46032
CHECK NUMBER: 179591
CHECK DATE: 11/24/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 370.20 REFUND PREMIUMS
t
Seelbring, James P HR
From: Lamb, Barbara A
Sent: Monday, November 23, 2009 12:16 PM
To: Spelbring, James P HR
Subject: Brainard Refund
e Please refund Mayor Brainard $370.20 from the medical escrow (301) fund. He pays the entire year's premium is
advance. Because we are having a premium holiday he will get back three (3) bi- weekly payments.
BW Medical 112.68
BW dental 10.72
BW Total= 123.40
123.40 3 370.20.
Barbara A. Lamb
Director of Human Resources
City of Carmel
One Civic Square
Carmel, IN 46032
Phone: 317- 571 -2471
Fax: 317- 571 -2409
Email: blamb()carmel.in.gov
Please consider the environment before printing this e -mail
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
James Brainard
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/23/09 Medical Claims Refund $370.20
Total $370.20
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 NO2 1123/09 WARRANT NO.
ALLOWED 20
James Brainard
IN SUM OF
$370.20
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Escrow
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
301 $370.20 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund