HomeMy WebLinkAbout203384 11/09/2011 CITY OF CARMEL, INDIANA VENDOR: 364990 Page 1 of 1
0 ONE CIVIC SQUARE C H C WELLNESS
CARMEL, INDIANA 46032 5440 N CUMBERLAND AVE #225 CHECK AMOUNT: $3,640.00
CHICAGO IL 60656 CHECK NUMBER: 203384
CHECK DATE: 11/9/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 21668 WL 3,640.00 WELLNESS PROGRAM
5440 North Curnherland Avenue �2� IN
Suite 225
Chicagyo, lalinols 60656 Invoice# WL
Date 1 1/2/2011
Ship 11/2/2071
Bill To Terms Net 30
Citv of'Carmel
Rep Ron
Attn: Sue Wolfgang
I Civic Square
Carmel, FN, 46032 Due Date 12/2/201 I
Quantity Item Code Description Price Each Amount
2 WLCSF 12 -Week Weight Loss Challenge. Set -up Fee for 2 350.00 700.00
locations
84 WLOT \Veight Loss Challenge I'articipam Fee 35.00 2,910.00
D Q
NOV 7 2011
By
Thank you for your business Total Due $;3.640.00
PLEASE, MAKE CHECK PAYABLE TO: CHC WELLNESS
R[INFFTANCE ADDRESS:
5440 NORTH CUMBERLAND AVE.
St1ITE 225
CHICAGO, U. 60656
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))
11/02/11 WL $3,640.00
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.
ALLOWED 20
CHC Wellness
IN SUM OF
5440 North Cumberland Avenue, Suite 225
Chicago, IL 60656
$3,640.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
21668 I WL I 43- 419.80 I $3,640.00 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
Monday, November 07, 2011
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund