The URL can be used to link to this page

Home My WebLink About178516 10/26/2009 *f CITY OF CARMEL, INDIANA VENDOR: 362529 Page 1 of 1 ONE CIVIC SQUARE DON CLEVELAND CHECK AMOUNT: $836.60 CARMEL, INDIANA 46032 141 STONY CREEK OVERLOOK NOBLESVILLE IN 46060 CHECK NUMBER: 178516 CHECK DATE: 10/26/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION 902 4230200 29.00 OFFICE SUPPLIES 902 4347500 807.60 COBRA i i HAR HARRIS N.A. 65969 P.O. BOX 94033 PALATINE. IL 60094 -4033 ACCOUNT NUMBER: Statement Period 09/17/09 TO 10/19/09 Ol DONALD H CLEVELAND PAGE 2 OF 8 2/ 5 0 Withdrawals and Other Debits Date Amount Description Sep 17 72.83 POS PURCHASE W /PIN RECORD NO. 167721 CARD NO. SHELL SERVICE STATION FISHERS IN Sep 21 500.00 ACH DEBIT WEB CHASE SPAY Sep 21 .143.45 AUTOMATIC DEBIT TRANSFER FROM LOANS Sep 21 100.00 ACH DEBIT PPD TCU RECURRING DEBIT ep 21 93.84 ACH DEBIT Check NBR. BOC KOHLS DEPT STORE 8005645740 Sep 21 62.50 ACH DEBIT PPD TCU RECURRING DEBIT Sep 24 35.51 POS PURCHASE W /PIN RECORD NO. 061622 CARD NO. CBANKS 689 NOBLESVILLE IN Sep 28 100.00 ACH DEBIT PPD TCU RECURRING DEBIT Sep 28 62.50 ACH DEBIT PPD TCU RECURRING DEBIT Sep 29 525.00 ACCT RECEIVABLE TRUNC Check NBR. ARC AMERICAN WATER CHECKPYMT Sep 30 21 9:: 00 ACH .DEBIT WEB PAY.PAL`: INST''X'FER Oct 01 200..00 DEBIT 'MEMO Oct 05 22.79 POS PURCHASE W /PIN RECORD NO. 647800 CARD NO. WAL MART 0923 NOBLESVILLE IN Oct 05 100.00 ACH DEBIT PPD TCU RECURRING DEBIT Oct 05 62.50 ACH DEBIT PPD TCU RECURRING DEBIT c 08 15.44 POS PURCHASE W /PIN RECORD N0, 144085 CARD NO. �7A1 GREED �OMP:4NY FISHERS IN KENSINGTON LASER WIRELESS PRO 72242 PILOT MOUSE NEW.... eBay (item Page 1 of 2 Listed in category: Computers Networking Keyboards, Mice Input Mice Item number: 160365282008 KENSINGTON LASER WIRELESS PRO 72242 PILOT I MOUSE NEW.... Item condition: New Sale date: Sep 29, 2009 Quantity: 1 i Price: US $29.00 Shipping: Read item description or contact seller for details. I See all details Returns: 7 day exchange, buyer pays return shipping I Read details Coverage: Pay with Pa)' al' and your full purchase price is covered See terms i Seller info dragonw 2656 100% Ask a question i j See other items i i Item specifics j Condition: New Brand: KENSINGTON I Connectivity: WIRELESS Shipping and handling Item location: Lebanon, PA, United States Shipping to: Worldwide .7 ZIP Cod e: 46060 Quantity: 1 Change country: United States t_ 1 Get Rates I Estimated delivery E i Varies i Seller ships within 1 day after receiving cleared payment. Domestic handling time I Will usually ship within 1 business day of receiving cleared payment. http://cgi.ebay.com/ws/eBayISAPI.dll?ViewltemVersion&item= 1603 652 82008&view- 10/6/2009 KENSINGTON LASER WIRELESS PRO 72242 PILOT MOUSE NEW.... eBay (item Page 2 of 2 I Return policy Item must be returned within Refund will be given as Return policy details 7 days after the buyer receives it Exchange The buyer is responsible for return shipping costs. Payment details Payment method Preferred /Accepted Buyer protection on eBay Paypar PayPal Preferred Pay with P2ryPat and your full M VISA purchase price is covered I see terms Immediate payment required for this item Immediate payment of US $29.00 is required. Seller's payment instructions I DELIVERY CONFIRMATION ON US ORDERS.. t Seller assumes all responsibility for this listing. Copyright 1995 -2009 eBay Inc. All Rights Reserved. Designated trademarks and brands are the property of their respective owners. Use of this Web site constitutes acceptance of the eBay User Agreement and Privacy Policy. http:// cgi. ebay. com/ ws /eBayISAPI.dll ?ViewItemVersion &item 160365282008 &view all... 10/6/2009 Monthly Medical Insurance Premiums Donald H. and Barbara L. Cleveland Oct -09 Donald: Medicare Part B $96.40 Amount due for October 2009 Humana Choice PPO 44.00 Total Don 140.40 Approved by Ron Carter Barbara: Anthem 809.72 Total Monthly 950.12 85% 807.60 Portion paid by City 15% 142.52 Your 2GOS MaritK[y Premlums for Med[care Part A (Hospital Insurance) monthly Premium Most people don't pay a Part A premium because they paid Medicare taxes while working. You pay up to $443' each month if you don't get premium -free Part A. Part B (Medical Insurance) Monthly Premium If Your Yearly Income Is You Pay File Individual Tax Return I File Joint Tax Return $85,000 or below #$214,001-$320,000 170,000 or below $96.40' $85,001 $107,000 170,001- $214,000 $134.90 $107,001 $160,000 $192.70' $160,001- $213,000 $320,001- $426,000 $250.50' above $213,000 above $426,000 $308.30' Note: If you get a monthly benefit payment from Social Security, the RRB, or the Civil Service, you must have your Part B premiums deducted from your monthly benefit payment If you don't get any of these benefit payments and choose to sign up for Part B, you, will get a bill. If you choose to buy Part A, you will always get a bill for your premium. You can mail your premium payments to the Medicare Premium Collection Center, P.O. Box 790355, St, Louis, MO 63179 -0355. If you get a bill from the RRB, mail your premium payments to RRB, Medicare Premium Payments, P.O. Box 9024, St. Louis, MO 63197 -9024. Part en espanol UMANA I Medicare Toll-free: 1 800 372 2147 ;d,vw., whoa Foil �,<<d it mou TTY users: 1 877 833 4486 I Print This Pag A Enlar a Text L He Return to Previous Screen Plan Details Humana Choice PPO Plans PPO R5826 -008 Monthly Plan Premium: $44.00 PI n Premiums for Pe with Extra Help Rx Coverage: Annual Part D Deductible $0.00 Annual Medical Deducti 0.0 0 Maximum Medical Out -of- $5,000.00 Pocket: Prescription Drug Coverage: Amount you pay per prescription Type of Drug Stage 1 Stage 2 Stage 3 Stage $0 -$295 $296- Over 4** $2700 $2700 Over $4350 Preferred $7 $7 100% 5% Generic Preferred $40 $40 100% 5% Brand Non Preferred $65 $65 100% 5% Brand Specialty 33% 33% 100% 5% Physician Detail: c Option to see physicians in- or out- of the plan's network. r No referrals required. You pay more for out -of- network services. Doctor Office Visits: Primary C are Physicia $15.00 C op ay Specialist: $35.00 Copay Hospitalization: $800.00 per admit https: /www.humana- medicare. com/ SeniorWizardNET /PlanDetails.aspx 3/27/2009 ANTHEM 8CBS|NINDIVIDUAL |ND|'MB| KY0308A645 ooszsz |35|\Vm Howard Ta|l m�� Cincinnati, OH 45206'1775 ^�101 0 �1;1`_1 Jil-"hidd^"~�.Bl"~=^�.�_~~^ lh,^�./�.~~u��=/~°* IDENTIFICATION #:0|8W62h29 Due Date: |U'0/'20Oo BU|'ow 09'(0-20) Covcm Period Fr 10-01-2009 #A|h4(XXUXXXXXX)DS()#|NDl-MBI KY01 3&645 C"vemoo Period Thn`u |0'3|-20m9 CD LN Cleveland, Barbara L W 141 St Creek Overlook Total Auovvo{U}uv: $809J2 Noblesville, IN 46060'5427 SEE REVERSE SIDE FOR BILLING DETAILS. 0oeoh.xmxhou(yoor hill o,micmviedin other payment o Did YOU know you can make y.w, payment over the phone? Foroeigunoc. please call tile Cou.v'u,Sc,vi,cph'mcnon1hCr|iutedwnUhckack"|'yoorNcoNicx/ionCan|. Cho /o mail in your poyoxn/? Please allow 7m|0 days /.`coyuuhnle\yyxCcyx/o(Io(yoo, payment. Please remember to list your 9-digil Identification Number on your check, include (lie lower portion ofth\u page and mail m t address specified. If you have already mailed in yonr payment, thank you lor YoUr continued membership with LIS. IMPORTANT NOTICE: Ifyou have received a reminder n front Andicin Blue Cr and BILIC Shield r��W\o�x past clue payment, this NU noc|odcsuU uuw u on /hx/ you ovz m keel) your policy in force. To avoid any lapse in corcmyc. the T^u| Amoom Due listed on this hill ommhc received by the Due Date. Ao/hcm B|uc Cr and Blue Shield's issuance 'f[his W| does not waive xxuxxrucmu| 611111 to automatically terminate your coverage for h6|on* pay premiums invfimdy manner. Payments recently mailed may not hcreflected. DETACH AND RETURN THIS SECTION WITH YOUR PAYMENT 'DOP40N'STAP1.E mxAxxcxxoKyr*vxyLxnoAwrxxwamuxCuooyx/.mmyo/xu` Cleveland, Barbara 1' AND mAu.lnTxxAuuuesxBELOW Subscriber ID# From Date Through Pate Due Date 018M62629 I OA) 1/2009 10/31/2009 1 0A) 1/2W9 Amount Due �y mint Paid Unit No. 002 INDiNo| z3 /_/4~�F-09 2,3 m,,v/ ,n VAI ��,��'��g�� ANTHEK4BCBS/NINDN/DUAL P0 Box 105874 Atlanta GA 30348-5874 1 9001954140000018226262971001200900000809720029 Si necesila ayuda en eslxifiol para entender este documento, puede soliciiarla sin costo adicional, llamando al mimero de sen al cliente que aparece al dorso de sit tarjeta de identificacion o en el folleto de inscripcicin. Invoice 059725077 PRIOR BILLING PERIOD COVERAGE FROM 09/01/2009 THRU 09 /30/2009 Previous Total Due $809.72 Payment Received on 08/28/2009 ($809.72) Outstanding Balance as of 09 -10 -2009 $0.00 CURRENT PERIOD COVERAGE FROM 10/01/2009 THRU 10/31/2009 Plan 11 $809.72 Current Period Total $809.72 PLEASE PAY THIS AMOUNT $809.72 ib1311IND2AB13 13 IND 00003131 001059725077 FIFTH THIRD BANK PROFESSIONAL MASTERCARD Page 1 of 4 Account Summary for Period Previous Balance $876.03 September 7, 2009 October 6, 2009 Payments Credits $876.03 Total Credit Limit $7,000 Purchases Cash Advances $973.29 Cash Limit $3,500 Other Charges $0.00 Available Credit $6,026 FINANCE CHARGES $0.00 Portion Available for Cash $3,500 New Balance $973.29 The Cash Limit is a portion of the Total Credit Limit. Minimum Payment Due $19.00 Payment Due Date November 2, 2009 Questions? Call Us During these tough economic times, we're pleased to provide you with good news. You now Customer Service have more time to make your payment. Your new payment date appears on this statement 1.800.972.3030 and will be at least 21 days from when your statement is mailed. Now your Professional MasterCard® works even harder for your business! You get automatic Send Payments to rebates on fuel and maintenance purchases. Visit easysavings.com for details. Fifth Third Bank PO Box 740789 Transactions Cincinnati, OH 45274 -0789 TRAN POST DATE DATE REFERENCE NUMBER DESCRIPTION AMOUNT Send Billing Inquiries to Payments Credits Customer Service 09/25 09/28 7594 MAIL PAYMENT BRANCH CINCINNATI OH $876.03 MD 1 MOC2G -4050 Purchases, Cash Advances Other Charges 38 Fountain Square Plaza 09/29 09/30 92729968 USPS POSTAL ST66100QPS KANSAS CITY MO $30.95 Cincinnati, OH 45263 09/28 09/30 92722647 ANTHEM BCBS INS PMT IN OH 809.72 10/01 10/02 92747831 CBSA 952 5936471 MN 66.31 10/01 10/02 92748078 CBSA 952 5936471 MN 66.31 Z m 0 r< U Please write your account number on your check made payable to Fifth Third Bank and mail portion below in return envelope. FIFTH THIRD BANK MADISONVILLE OPERATIONS CENTER Print address changes below. MD1MOC2G CINCINNATI. OH 45263 9 Street Apt.# DONALD H CLEVELAND 0044355 City State Zip 141 STONY CREEK OVERLOOK Home Phone Alternate Phone NOBLESVILLE IN 46060 -5427 Account Number - New Balance $973.29 Minimum Amount Due $19.00 Payment Due Date November 2, 200 FIFTH THIRD BANK PO BOX 740789 CINCINNATI OH 45274 -0789 Total Enclosed 10/23/09 $0.00 $417.00 CHASE 4ccount number: 1 want to purchase optional Make your check payable to: Chase Payment Protector Chase Card Services. Plan. I've read the Benefits Please write amount enclosed. Disclosures on back of insert. New address or e Print on back. Initials Date 31647 BEX Z 27109 D DONALD H CLEVELAND 141 STONY CREEK OVERLOOK CARDMEMBER SERVICE NOBLESVILLE IN 46060 -5427 PO BOX 94014 PALATINE IL 60094 -4014 Statement Date: s late- 08/29/09 09!28/09 Manage your account online: trom CHASE Co www.chase.com /creditcards Minimum Payment: $417.00 Payment Due Date: 10/23/09 Additional contact information ACCOUNT SUMMARY Account Number: conveniently located on reverse side Previous Balance 46015MM Total Credit Line $30,000 Payment, Credits $500.00 Available Credit $9,109 Purchases; Cash, Debits +$961.10 Cash Access Line $30,000 Finance Charges +$57.87 Available for Cash $9,109 New Balance ACCOUNT ACTIVITY Date of Transaction Merchant Name or Transaction Description S Amount 09/19 Payment Thank You 500.00 08/29 ANDY MOHR PONTIAC BUIC NOBLESVILLE IN 275:68 08/27 WAL -MART #0923 SE2 NOBLESVILLE IN 10.00 GS/31 HHGREGG- NOBLESVILLE #0 NOBLESVILLE IN 105.97 09101 HUMANA HEALTH PLAN,INC 08009922551 KY 44.00 09/01 WM SUPERCENTER SE2 NOBLESVILLE IN 5.71 09/04 CORK N CLEAVER FT WAYNE IN 32.07 09/06 OLD SPAGHETTI FCTRY 16 INDIANAPOLIS IN 27.94 09/06 PARISIANS #564 INDIANAPOLIS IN 37.24 09/07 GAS AMERICA 500000505 NOBLESVILLE IN 24.01 09/08 BARNES NOBLE #214Q90 NOBLESVILLE IN 25.00 09/08 HOBBY -LOBBY #0182 CARMEL IN 24.59 09/09 ORKIN, INC #0576 404 888 -2000 IN jf 95.00 09108 HOBBY -LOBBY #0182 CARMEL IN (O 17.54 09/10 INDIANA NEWSPAPERS INC 317 444 -8058 IN 15.87 09/07 WAL -MART #0923 SE2 NOBLESVILLE IN 15.00 09 /1b INDIANA NEWSPAPERS INC 317 444 -8058 IN 2.63 09/08 WAL -MART #0923 SE2 NOBLESVILLE IN 6.55 09/14 WM SUPERCENTER SE2 NOBLESVILLE IN 32.59 09/15 YMCA OF GRTR INDIANAPO INDIANAPOLIS IN 32.00 09/14 WAL -MART #0923 SE2 NOBLESVILLE IN 40.00 09120 COMFORT INN OF BEDFORD BEDFORD IN 90.71 PrescrbeQby State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 DO" C/6`14 Purchase Order No. 1 QvN loU� Terms y6 EGG Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) q/2 o 2 /f/k'li�/ 21_ C!o io /D 1o0 109 q risory <�r- X07 60 f h Total ._4 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. -P 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 ell IN SUM OF 36.5 ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 02 2. �1230 -V bill(s) is (are) true and correct and that the /O oi o3 materials or services itemized thereon for which charge is made were ordered and received except %O 200,' Sig ture irn^+^� -4 k eratic Cost distribution ledger classification if Ti le claim paid motor vehicle highway fund