HomeMy WebLinkAbout180269 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 354957 Page 1 of 1
0 ONE CIVIC SQUARE SPECTRUM HEALTH SYSTEMS CHECK AMOUNT: $7,406.00
�a CARMEL, INDIANA 46032 3535 E 96TH ST SUITE 114
INDIANAPOLIS IN 46240 CHECK NUMBER: 180269
CHECK DATE: 12/8/2009
DEPARTMENT ACCOUNT PO NUMBER I NVOI CE NUMBER AMOUNT DESCRIPTION
1201 4341980 2868 7,406.00 WELLNESS PROGRAM
Spectrum Health Systems, LLC R 0 1 9 37,
In voice
provider of the Express Health Program
Date Invoice
3535 East 96th Street Suite 114�� �o
Indianapolis, IN 46240 11/23/2009 2868
12�
Bill To
City of Carmel
Barbara Lamb
One Civic Square
Carmel, IN 46032
P.O. No. Terms Project
Upon Receipt
Quantity Description Rate Amount
180 Civilian Participants Screened 150.00 27,000.00
130 Sworn Participants 80.00 10,400.00
123 Tobacco Breathalyzer Tests 6.00 738.00
2 Previously Billed Installments 15,366.00 30,732.00
D
Qa
DEC 0 7 Z009
By
Please contact Jamie Curts for any questions and or concerns: 317- 573 -7600 or 888 -573 -1568
T ota l $7,406.00
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
Spectrum Health Systems, LLC Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/23/09 2868 Wellness Program $7,406.00
Total $7,406.00
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 N01 2/07/09 WARRANT NO.
ALLOWED 20
Spectrum Health Systems; LLC
IN SUM OF
3535 East 96th Street, S uite 114
Indianap IN 46240
$7,406.00
ON ACCOUNT OF APPROPRIATION FOR
General Fund
1201 Human R esources
Board Members
PO# or D PT. INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1201 2868 419 -80 $7,406.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signa yxe
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund