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HomeMy WebLinkAbout174279 07/08/2009 CITY OF CARMEL, INDIANA VENDOR: 362529 Page 1 of 1 ONE CIVIC SQUARE DON CLEVELAND CARMEL, INDIANA 46032 141 STONY CREEK OVERLOOK CHECK AMOUNT: $832.60 NOBLESVILLE IN 46060 CHECK NUMBER: 174279 CHECK DATE: 7/8/2009 DLPA RTMENT ACCOUNT PO NUMBER INVOICE NUM A MOUN T DESCRIPTION 902 4347500 070109 807.60 GENERAL INSURANCE 902 4230200 16817 25.00 OFFICE SUPPLIES Monthly Medical Insurance Premiums Donald H. and Barbara L. Cleveland Jul -09 Donald: Medicare Part B $96.40 Amount due for July 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 15% 142.52 Your 2009 Monthly Premiums far Medicare 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 File Joint Tax Return $85,000 or below $170,000 or below $96.40' $85,001 $107,000 $170,001- $214,000 $134.90' $107,001- $160,000 $214,001- $320,000 $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 Payment Due Date New Balance Past Due Amount Minimum Payment 07/23109 Make your check payable to: y Chase Card Services. Please write amount enclosed. New address or e-mail? Print on back, 38587BExZ 17909D DONALD H CLEVELAND 141 STONY CREEK OVERLOOK CARDMEMBER SERVICE NOBLESVILLE IN 46060 -5427 PO BOX 94014 PALATINE IL 60094 -4014 Statement Dat f-9F1 C e: ❑-9 A S C O 05/29/09 06/28109 ©Manage your account online: www. ch a s e. co m/ c re d i tca rd s Minimum Payment: $394.00 Payment Due Date: 07123/09 Additional contact information ACCOUNT SUMMARY conveniently located on reverse side Previous Balance Total Credit Line $30,000 Payment, Credits Available Credit Purchases, Cash, Debits Cash Access Line $30,000 Finance Charges Available for Cash New Balance ACCOUNT ACTIVITY Date of Transaction Merchant Name or Transaction Description Amount 06/15 Payment Thank You 06/02 HUMANA HEALTH PLANJNC 8009922551 KY 44.00 06/02 CLARKS CORVAIR PARTS SHELBURNE FAIL MA 14.57 06/08 CARMEL SYMPHONY ORCHES CARMEL IN 215.00 06/10 INDIANA NEWSPAPERS INC 317- 444 -8058 IN 12.00 06/07 WM SUPERCENTER SE2 NOBLESVILLE IN 21.55 06 /16 THE CARE GROUP LLC INDIANAPOLIS IN 35.00 06115 YMCA OF GRTR INDIANAPO INDIANAPOLIS IN 32.00 06117 WAL -MART #0923 SE2 NOBLESVILLE IN 40.00 FINANCE CHARGES Finance Charge Transaction Daily Periodic Rate Corresp. Average Daily Due To Fee Accumulated FINANCE Category 31 days in cycle APR Balance Periodic Rate Service Charge Fin Charge CHARGES Purchases V .00890% 3.25% $61.93 $0.00 $0.00 $61.93 Cash advances V .05271% 19.24% $0.00 $0.00 $0.00 $0.00 $0.00 Convenience check V .00890% 3.25% Qw;zqp $1.59 $0.00 $0.00 $1.59 Balance transfer V.00890% 3.25 $5.53 $0.00 $0.00 $5.53 Total finance charges $69.05 Effective Annual Percentage Rate (APR): 3.25 Please see Information About Your Account section for balance computation method, grace period, and other important information. The Corresponding APR is the rate of interest you pay when you carry a balance on any transaction category. The Effective APR represents your total finance charges including transaction fees such as cash advance and balance transfer fees expressed as a percentage. IMPORTANT NEWS Get unlimited local long distance calling with Vonage for the low price of $24.99 /Month. 25 great features no extra cost. High speed internet required. See Vonage.com /911. For details call Vonage at 888 -589 -3608. Identify yourself as a Chase Cardmember (this is NOT a Chase customer service Limited time offer on British Airways... Save $100'r/t. Book a round -trip flight on British Airways worldwide in World Traveller Plus or World Traveller between Mar 23- Aug 31, 2009. Visit ba.com /chase100 to book your Flight. Offer ends June 30, 2009. Terms conditions apply. This Statement is a Facsimile Not an original 0000001 FIS33338 D 8 000 N Z 28 09/06128 Page 1 o11 05686 MAMA 38587 17910000080003858701 X INS13877 Fifth Third Bank I Manage Accounts Credit Card Account Activity Page 1 of 1 FI�'Z°H 'T`I -1IR�3 BANK The things we coo for dreams Account Balances Account Nicknames Account Activity Welcome, DONALD H CLEVELAND Tuesda June 30, 2009 A ccount Ac tivity Account Summar I Account Statements Exi Account Statement Period: Current Statement! Posted Transactions ( Advanced Search: Keyword Posti ng-Date Trans D ate Debit Credit(_). Description 06/29/09 06/26/2009 $809.72 ANTHEM BCBS INS PMT IN 866 649 -2034 OH 06/24/09 06/23/2009 $1,577.00 MAIL PAYMENT BRANCH CINCINNATI OH Transactions and other information that appear on this page have occurred since your last statement cycle date. Please s statement period to review previous account activity. I Di sclosure /E rror R Copyright 2009 Fifth Third Bank, Member FDIC, Equal Hm.+sing Lender, All Rights Reserved Conta ct_Us I servi Cent er. I Help FA.- a I Privacy &Se https: /www.5 3 com/servlet/efsonline/ account history. html ?Trans S ortCode= DATE,REV E... 6/30/2009 ANTHEM BCBS IN INDIVIDUAL INDI -MB 1 KY0303A645 A nthem. 1351 Wm Howard Taft Anthem. V. A Cincinnati, OH 45206 -1775 An indepcodw liaosec of the Blue Cress snd Blue Shield Association. Aoth m Blue Cross Blue Shield is the trade eame of the A.6— lnsotmas Compeei.. Inc. dWegiaaed mahv Bloc Cress and Blue Shield A. -.i"— IDENTIFICATION 018M62629 0611091VRU0457 B41ND 4288 01 Due Date: 07 -01 -2009 I. I. I I l l l l 1 I l l l l l I i l l l l 1 1 1 1 I. I l l 1 111111111 I l l I. I l l I l l l l i l l 1111 Billin Date: 06 -10 -2009 c #BWNCQXF Coverage Period From: 07 -01 -2009 N #AIMOOOOOOOOOODSO#INDI -MB 1 KY0303A645 Coverage Period Through: 07 -31 -2009 Cleveland, Barbara L 141 Stony Creek Overlook G y -y6 3 9 Jl Total Amount Due: $1,619.44 Noblesville, IN 46060 -5427 SEE REVERSE SIDE FOR BILLING DETAILS. Questions about your bill or interested in other payment options? Did you know you can make your payment over the phone? For assistance, please call the Customer Service phone number listed on the back of your Identification Card. Choosing to mail in your payment? Please allow 7 to 10 days to ensure timely processing of your payment. Please remember to list your 9 -digit Identification Number on your check, include the lower portion of this page and mail to the address specified. If you have already mailed in your payment, thank you for your continued membership with us. IMPORTANT NOTICE: If you have received a reminder notice from Anthem Blue Cross and Blue Shield regarding a past due payment, this bill includes all amounts that you owe to keep your policy in force. To avoid any lapse in coverage, the Total Amount Due listed on this bill must be received by the Due Date. Anthem Blue Cross and Blue Shield's issuance of this bill does not waive its contractual right to automatically terminate your coverage for failure to pay premiums in a timely manner. Payments recently mailed may not be reflected. DETACH AND RETURN THIS SECTION WITH YOUR PAYMENT DO NOT STAPLE MAKE CHECKS PAYABLE TO ANTHEM BLUE CROSS BLUE SHIELD Cleveland, Barbara L AND MAIL TO THE ADDRESS BELOW Subscriber ID From Date Through Date Due Date 018M62629 07/01/2009 07/31/2009 07/01/2009 Amount Due Amount Paid $1,619.44 909,7e— Unit No. 002 INDI -MB 1 C r 1-5/ ;t�4 I /91), iR y 5 P 3 S' C T 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 l 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ANTHEM BCBS IN INDIVIDUAL PO Box 105674 Atlanta GA 30348 -5674 Si necesita ayuda en espanol para entender este documento, puede solicitarla sin costo adicional, llamando al nlimero de servicio al cliente que aparece al dorso de su tarjeta de identificaci6n o en el folleto de inscripci6n. Invoice 056891576 PRIOR BILLING PERIOD COVERAGE FROM 06/0112009 THRU 06/30/2009 Previous Total Due $809.72 Outstanding Balance as of 06 -10 -2009 $809.72 CURRENT PERIOD COVERAGE FROM 07/01/2009 TIIRU 07/31/2009 Plan 11 $809.72 Current Period Total $809.72 PLEASE PAY THIS AMOUNT $1,619.44 30 /qTJ 2.G v S `t-9 ib13BIND211B13 B IND 00004288 000056891576 �����U���N��� *x�m�m��m��m m~��~pu 943O Priority Way West Drive Indianapolis, IN46J40 S.O'Date: 7/6/09 P:-317-580'0100 F:317'580'2500 S.O^Nommbmr:. 16817 Printed Date: 7/6/2009 8:31:25AM Entered by: bbs302 Bill To: City Of Carmel Ship To: City Of Carmel Attn: Accounts Payable Attn: Accounts Payable 1 Civic So 1 Civic Sq Carmel, IN 46032-7569 Carmel, IN 46032'7569 rm C000 15 Days COD CUST P/U 7/6/09 Thank you for your business Joe Doyle 522-2150. Joe Doyle 2 0 If erg Signature Date Page 1 of VTReceipt Page 1 of 1 BRADEN BUSINESS SYSTEMS 9430 PRIORITY WAY WEST INDIANAPOLIS, IN 46240 317 -580 -0100 Date: 7/6/2009 Time: 8:47 AM EDT Trans Type: Sale Transaction 14015850 Name: DONALD H CLEVELAND Account: * Exp Date: Card Type: Street: 1 CIVIC SQUARE Zip: 46032 Entry: Manual PO SU AuthCode: 02434Z Result: APPROVED Message: APPROVAL Batch Num: 381 Description Total Amt: $25.00 I Agree to Pay Above Total Amount According to Card Issuer Agreement (Merchant Agreement if Credit Voucher) Signature X Merchant Copy https: /reports.secureexchange. net /adminNTReceipt.aspx ?VTResult Date= 7 %2f6 %2f2009... 7/6/2009 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 //���PS�i���a /i1/ y��� Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 7/0/ 70c /O9 E 3�2 >6 Total j 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 VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF �04 1 2 1 c°S6/1 1 /rte, o ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or X02 070/ o y y 3 y7s� S�07 -4� bill(s) is (are) true and correct and that the 7 't :7- S materials or services itemized thereon for which charge is made were ordered and received except 7 20 09 Signature Director of Operations Cost distribution ledger classification if Title claim paid motor vehicle highway fund