HomeMy WebLinkAbout204733 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 364990 Page 1 of 1
ONE CIVIC SQUARE C H C WELLNESS CHECK AMOUNT: $560.00
CARMEL, INDIANA 46032 5440 N CUMBERLAND AVE #225
CHICAGO IL 60656 CHECK NUMBER: 204733
CHECK DATE: 12/20/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 21668 C1692.01 560.00 WELLNESS PROGRAM
glov
5440 North Cumberland Avenue
f Suite 225
Chicago, Illinois 60656 Invoice c1692.a1
Date 11/29/2011
Ship 11/29/2011
Bill To Terms Net 30
City of Carmel Rep Ron
Attn: Barb Lamb
1 Civic Square
Carmel, IN, 46032 Due Date 12/29/2011
Quantity Item Code Description Price Each Amount
4 H&;W Company Health Wellness Uninsured Employees: 140.00 560.00
Katie Lindamood
Brett Ransford
Vicki Bailey
Bonnie Callahan
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Thank you for your (business. Total D ue: $560.00
PLEASE MAKE CHECK PAYABLE TO: CHC WELLNESS
REMITTANCE ADDRESS:
5440 NORTH CUMBERLAND AVE.
SUITE 225
CHICAGO, IL 60656
VOUCHER NO. WARRANT NO.
ALLOWED 20
CHC Wellness
IN SUM OF
5440 North Cumberland Avenue, Suite 225
Chicago, IL 60656
$560.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR 'Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
21668 01692.01 43- 419.80 $560.00 I 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, December 19, 2011
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
11/29/11 C1692.01 $560.00
I 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