HomeMy WebLinkAbout177402 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 354957 Page 1 of 1
ONE CIVIC SQUARE SPECTRUM HEALTH SYSTEMS CHECK AMOUNT: $15,366.00
CARMEL, INDIANA 46032 3535 E 96TH ST SUITE 114
INDIANAPOLIS IN 46240 CHECK NUMBER: 177402
CHECK DATE: 9/1512009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION.
1201 4341980 2806 12,425.75 WELLNESS PROGRAM
1201 R4341980 19371 2806 2,940.25 WELLNESS PROGRAM
Spectrum Health Systems, LLC Invoice
provider of the Express Health Program
Date Invoice
3535 East 96th Street Suite 114
Indianapolis, IN 46240 8/28/2009 2806
D�
Bill To CY.
City of Carmel C)
Barbara Lam 1 l �J
One Civic Square
L
Carmel, IN 46032
P.O. No. Terms Project
Upon Receipt
Quantity Description Rate Amount
I Express Health Program 2009 15,366.00 15,366.00
2nd of 3 invoices.
Best of Health!
Total 15,366.00
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
Spectrl.Im Health Systems Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
06/28/09 2606 xpress Health Program 2009 155,366. 9e
2nd of 3
Total 15 366.00
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 NOO�.TT4TG9–WARRANT NO.
ALLOWED 20
Spectrum Health Systems
IN SUM OF
3535 East 96th Street, Suite 114
Indianapol IN 4tj24U
$15,366.00
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1201 Human Resources
Board Members
Po# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
final 2806 419 80 $2,940. 25 materials or services itemized thereon for
which charge is made were ordered and
5 received except
20
Sign re
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund