179569 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 358813 Page 1 of 1
ONE CIVIC SQUARE ANGIE'S LIST
CARMEL, INDIANA 46032 1030 E WASHINGTON STREET CHECK AMOUNT: $59.00
INDIANAPOLIS IN 46202 CHECK NUMBER: 179569
CHECK DATE: 11124/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUM AM OUNT DESCRIPTION
1125 4355200 1007330 59.00 SUBSCRIPTIONS
lis YOUR MEMBERSHIP
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Indianapolis, IN 46202 Save $5 when you renew
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AUDREY KOSTRZEWA
Carmel Clay Parks Recreation
1411 E 116th St NO Ji
Carmel, IN 46032 -7611
PO- Tt -B1 -S5
750,000 NEIGHBORS CAN'T BE WRONG.
Experience counts when hiring service �3 S-5- [S
companies. Angie's List can help.
Mark A.
40,000 new reviews every monti n,— 5i Woodbury, MN
more than 400 service categorief�)
including doctors! t E l+ d o lil�t�
NO 2009
N's Uke
Exclusive discounts from highly rated �1
companies. �Ys .......................Gave �Il msaimds
@9 Vila ids and
Help from our Complaint Resolution Team �1
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Angie liSt HEALTHCARE SERVICE PROVIDER REPORT FORM
Provider Name Provider Phone
Provider Address
City State Zip
Did the provider perform an evaluation of treatment? (more weight is given to a report where an evaluation has been completed) OY ON
Approx. out of pocket cost S Date(s)
Category
(Pediatrician, Pharmacy Dentist, etc. if unsure, leave blank)
Please provide a description of your experience. (as much information as possible)
Member Comments: (example. Dr. Smith was punctual, very polite and knowledgeable)
1. Overall Experience: OA OB OC OD OF ON /A 6. Bedside Manner: OA OB OC OD OF ON /A
2. Availability: OA OB OC OD OF ON /A 7. Communication: OA OB OC OD OF ON /A
3. Environment: OA OB OC OD OF ON /A 8. Duality of Treatment: OA OB OC OD OF ON /A
4. Punctuality: OA OB OC OD OF ON /A 9. Effectiveness of Treatment: OA OB OC OD OF ON /A
5. Friendliness of Staff: OA OB OC OD OF ON /A 10. Billing and Admin: OA OB OC OD OF ON /A
Would you use this provider again? OY ON If you weren't satisfied would you like help from Angie's List? OY ON
Your Name Phone
E -mail
Please remember that this report information will be available to the medical service provider being rated. I confirm that the information contained in
this Service Evaluation Form (i) is true and accurate and (ii) represents my actual first -hand experience. I acknowledge and understand that Angie's
List is relying upon the accuracy of the information in order to serve other members. I confirm that I do not work for, am not in competition with, or
am not in any way related to the service provider in this report.
Signature Date
1
Ang ie& ,a, l ist YOUR MEMBERSHIP
EXPIRES a
SOOPI.
1030 E. Washington St. Save $5 when you renew
Indianapolis, IN 46202 online at AngiesList.com.
memberservices @angieslist.com Use promo code WE11312110V.
(Annual memberships only. Not valid with other offers.)
AUDREY KOSTRZEWA
t Carmel Clay Parks Recreation
1411 E 116th St
Carmel, IN 46032 -7611
PO- T1 -81•S5
750,000 NEIGHBORS CAN'T BE !WRONG. F#3 w s
Experience counts when hiring service 5 S (0) 0
companies. Angie's List can help.
Mark A.
40,000 new reviews every mont Woodbury, MN
more than 400 service categorie l a
including doctors! ae i lk
NO 2009
Exclusive discounts from highly rated
By. have thousands
companies.
®f friends and
Help from our Complaint Resolution Team
if a project doesn't go according to plan. neighbors to ask
for hekp o ®o
eJ
,_....._�_�..��W_.�.._ >~`�•.t s� .�.�3'c �s'�.t� r ..cw A
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Angie liSt HEALTHCARE SERVICE PROVIDER REPORT FORM
Provider Name Provider Phone
Provider Address
city State Zip
Did the provider perform an evaluation of treatment? (more weight is given to a report where an evaluation has been completed) OY ON
Approx. out of pocket cost S Date(s)
Category
(Pediatrician, Pharmacy, Dentist, etc. if unsure, leave blank)
Please provide a description of your experience (as much information as possible)
Member Comments: (example: Or. Smith was punctual, very polite and knowledgeable)
1. overafl Uperfenm OA OB OC OD OF ON /A 6. Bedside Manner. OA OB OC OD OF ON /A
2. Availability: OA OB OC OD OF ON /A 7. Communication: OA OB OC OD OF ON /A
3. Environment: OA OB OC OD OF ON /A B. Quality of Treatment: OA OB OC OD OF ON/A
4. Punctuality: OA OB OC OD OF ON /A 9. Effectiveness of Treatment: OA OB OC OD OF ON /A
5. Friendliness of Staff: OA OB OC OD OF ON /A 10. Billing and Admin: OA OB OC OD OF ON /A
Would you use this provider again? OY ON If you weren't satisfied would you like help from Angie's Ust? OY ON
Your Name Phone
E-mail
Please remember that this report information will be available to the medical service provider being rated. I confirm that the information contained in
this Service Evaluation Form (i) is true and accurate and (ii) represents my actual first -hand experience. I acknowledge and understand that Angie's
List is relying upon the accuracy of the information in order to serve other members. I confirm that I do not work for, am not in competition with, or
am not in any way related to the service provider in this report.
Signature Date
Let us know which healthcare providers are great and which ones are lousy!
Include this report when you renew by mail. Or submit a report online or by phone today.
i
AUDREY KOSTRZEWA Please correct your contact information (if necessary).
1411 E 116th St
Carmel, IN Name:
46032 -7611
Address:
City: State: Zip:
audreyk @carmelclayparks.com 73
Phone: 7 1 J Ext.
E -mail:
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
358813 Angie's List Terms
1030 E Washington St
Indianapolis, IN 46202
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1114109 1007330 Membership 2010 59.00
Total 59.00
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.
358813 Angie's List Allowed 20
1030 E Washington St
Indianapolis, IN 46202
In Sum of
59.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #1TITLE AMOUNT Board Members
Dept
1125 1007330 4355200 59.00 1 hereby certify that the attached invoice(s), or
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
19 -Nov 2009
i_
Signature
59.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund