176785 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 00352957 Page 1 of 1
ONE CIVIC SQUARE HOPE HEALTH
CHECK AMOUNT: $1,835.95
CARMEL, INDIANA 46032 350 E. MICHIGAN AVENUE, SUITE 301
y off i a KALAMAZOO MI 49007 -9834 CHECK NUMBER: 176785
CHECK DATE: 9/2/2009
`DEPARTMENT ACCOUNT PO NUMBER INV N AMOU DESCRIPTION
1201 4341980 420122 1,835.95 WELLNESS PROGRAM
INVOICE 4 HP 420122
CLIENT 166655
HFALTN Exclusive Distributor IHAC, Inc. PAGE 1
Q TAX ID 38- 1784210
DATE 8/18/2009
Total Invoice Charges due on or before September 7, 2009 $1,835.95
BILLED TO: CREDIT CARD PAYMENTS ON REVERSE
OR PLEASE MAKE CHECK PAYABLE TO:
Shelly Lin elbaugh
Office Administrator Hope Health /IHAC
City of Carmel 35D East Michigan Suite 301
One Civic Square Kalamazoo, MI 49007 -3851
Carmel IN 46032
SEND THIS PORTION WITH YOUR PAYMENT
RETAIN THIS PORTION FOR YOUR RECORDS
350 East Michigan Avenue, Suite 301 INVOICE HP 420122 CLIENT 166655
Kalamazoo, MI 49007 -3851
(269) 343 -0770
DATE 8/18/2009
Quantity Item Description Unit Cost Total Cost
650 765 HOPE Health Calendar 2010 $2.580 Ea. 1,677.00
Cover fla 69.00
Shipping Handling 89.95
THANK YOU FOR YOUR ORDER! TOTAL INVOICE CHARGES $1,835.95
Please call 1- 800 334 -4094 if you have any questions.
Please visit our Web site Q www.hopehealth.com
EPAYMIEMT BY CREDIT C&RD-0
VISA, MasterCard. Discover and American Express are accepted. For Michigan residents, 6% sales tax has beell
added. If your orofflazation is tax exempt in Michigan., please include your tax ID
F For faster processing call 1-800-334-4094, FAX to (269) 343-6260, or fill out below and relL11
1 WOUld like to charae
zn t w o n credit card (check one):
VISA
Ll El
CREDIT A R 1) N L B E R MO, YR
I I
Authorized Signature: EXPIRATION DA I F
Client
Invoice
Prescribed by 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
H Health/IHAr- Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
08/18 ope Health Calendais (650) i�4 835-95
Total $1,835.95
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. ftRRANT NO.
ope eat /IHAC ALLOWED 20
360 East Michigan, Suite 301 IN SUM OF
Kalam@ Zon R' 49007
$1,835.95
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1201 Human Resources
Board Members
DEPT. or INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
420122 419 -80 $1, 835.96iaterials or services itemized thereon for
which charge is made were ordered and
received except
20
Sign re
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund