166392 11/24/2008 CITY OF CARMEL, INDIANA VENDOR: 354957 Page 1 of 1
ONE CIVIC SQUARE SPECTRUM HEALTH SYSTEMS
i' CHECK AMOUNT: $27,177.18
CARMEL, INDIANA 46032 3535E 96TH ST SUITE 114
y, oN INDIANAPOLIS IN 46240 CHECK NUMBER: 166392
CHECK DATE: 11124!2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUM AMOUNT DESCRIPTION
1201 4341980 2584 20,793.23 WELLNESS PROGRAM
1201 84341980 .16622 2584 6,383.95 WELLNESS PLAN
Spectrum Health Systems Invoi
/�4 3535 East 96th Street Suite 114
Indianapolis, IN 46240 Date Invoice
11/14/2008 2584
�N t
Bill To
City of Carmel
Barbara Lamb
One Civic Square
Carmel, IN 46032
P.O. No. Terms Project
Upon Receipt
Quantity Description Rate Amount
89 Civilian fingerstick screenings onsite 125.00 11,125.00
109 Civilian blood draw screenings onsite 170.00 18,530.00,
143 Civilian unscreened participants 57.00 8,151.00
255 Police and lire ❑nscreened participants 57.00 14,535.00
1 Incentive Balance not covered by contract 4,214.18 4,214.18
2 Previously Billed Installments 14,689.00 29,378.00
Please contact Jamie Curts for any questions and or concerns-317- 573 -7600 or 888 573 -1560
Total $27,177.18
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
spectrum Health Systems Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1 18
(3rd of 3 invoices)
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.
11/21Q
ALLOWED 20
�oectrum Health Systems
IN SUM OF
3535 East 96th Street, Suite 114
Indianapolis, IN 46240
$27,177.18
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1201 Human Resources
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
final 2584 95 materials or services itemized thereon for
which charge is made were ordered and
1201 2584 419-80 $20,793.23 received except
20
atr7�_, 4;;�:
nature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund