157252 03/05/2008 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $3,179.85
t CARMEL, INDIANA 46032 EAP
8401 HARCOURT ROAD
CHECK NUMBER: 157252
INDIANAPOLIS IN 46260
CHECK DATE: 3/5/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 R4347500 16049 5- 20376299 3,179.85 EAP SERVICE
ST VINCENT EMPL. ASST. PROGRAM
8401 HARCOURT RD
INDIANAPOLIS IN 46260 Date Account Number Balance
02/13/08 5- 20376299 3179.85
*CITY OF CARMEL
LAMB,BARB
CITY HALL 1 CIVIC SQUARE
CARMEL,IN 46032
Please_, enclose top portion with payment.
Rate: 2.15 Number of Employees: 493
ACCT 5- 20376299 PATIENT: *CITY OF CARMEL CHG AMT PAY /ADJ BALANCE
INVOICE 051962882
EMP PROVIDER
01/01/08 JANUARY 2008 1059.95
01/01/08 FEBRUARY 2008 1059.95
01/01/08 MARCH 2008 1059.95
INVOICE BALANCE: 3179.85
Account 0 -30 days 31 -60 days 61 -90 days X90 days Balance Due
5- 20376299 0.00 3179.85 0.00 0.00 3179.85
PAGE: 1
ST VINCENT EMPL. ASST. M F 9a.m. to 4p.m.
8401 HARCOURT RD Ph: 317 -338 -4900
INDIANAPOLIS IN 46260
Prescribed b�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
St Vince Employee Assistance Program Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
02/13/08 5 903 76-29 P— Pregram la Marc zood $3,179.85
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.
o3/o3ios 1
ALLOWED 20
'St Vincent Employ Assistance prog ram
IN SUM OF
1 3401 Harcourt Road
Indianapolis, 46260
$3,179.85
ON ACCOUNT OF APPROPRIATION FOR
GENERAL FUND
1205 Administration
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
artial 0 materials or services itemized thereon for
which charge is made were ordered and
received except
20
;,12-91 natu
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund