HomeMy WebLinkAbout206162 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 364990 Page 1 of 1
ONE CIVIC SQUARE C H C WELLNESS
CARMEL, INDIANA 46032 5440 N CUMBERLAND AVE #225 CHECK AMOUNT: $1,960.00
CHICAGO IL 60656
CHECK NUMBER: 206162
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 21668 WL1317 1,960.00 WELLNESS PROGRAM
5440 North Cumberland Avenue IN
v ®v Suite 225
Chicago, Illinois 60656 Invoice WL1317
REDEFINING HEALTH Date 1/31/2012
Ship 1/31/2012
Bill To Terms Net 30
City of Carmel Rep Ron
Attn: Sue Wolfgang
1 Civic Square
Carmel, IN, 46032 Due Date 3/1/2012
Quantity Item Code Description Price Each Amount
2 WLCSF Weight Loss Challenge Set -up Fee 250.00 500.00
78 WLCPF Weight Loss Challenge Participant Fee 25.00 1.950.00
1 CREDIT Available Credit 490.00 490.00
D Q
FEB 1 3 2012
By
Thank you for your business Total Due: $1,960.00
PLEASE MAKE CHECK PAYABLE TO: CHC WELLNESS
REMITTANCE ADDRESS:
5440 NORTH CUMBERLAND AVE.
SUITE 225
CHICAGO, IL 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))
01/31/12 WL1317 $1,960.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
CHC Wellness IN SUM OF
5440 North Cumberland Avenue, Suite 225
Chicago, IL 60656
$1,960.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
21668 WL1317 43- 419.80 $1,960.00 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, February 13, 2012
Directo HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund