HomeMy WebLinkAbout176447 08/19/2009 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: 176447
CHECK DATE: 8/1912009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 19371 2782 15,366.00 WELLNESS PROGRAM
of
Spectrum Health Systems, LLC t�� Invoice
provider of the Express Health Program
Date Invoice
3535 East 96th Street Suite 114
Indianapolis, IN 46240 7/30/2009 2782
Bill To
City of Carmel
Barbara Lamb
One Civic Square
Carmel, IN 46032
P.O. No. Terms Project
Upon Receipt
Quantity Description Rate Amount
1 Express Health program 2009 15,366.00 15,366.00
1 st of 3 invoices per proposal: 3rd invoice will be adjusted to reflect actual employee
participation at each level of service.
We appreciate our partnership. 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
Spectrum Health Systems Purchase Order No.
Terms
1
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2782 Express 1 lealth Program 2009 $15,366.00
Total
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 NCb NO.
ALLOWED 20
Spectrum Health Systems
3535 East 96th Street, Suite 114 IN SUM OF
lRd IN 46240
$15, 366.00
ON ACCOUNT OF APPROPRIATION FOR
GENERAL FUND
1201 Human Resources
Board Members
PO# or DEPT. INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
19371 bill(s) is (are) true and correct and that the
partial 2782 419 -80 $15,366.00materials or services itemized thereon for
which charge is made were ordered and
received except
20
T
Sig ture-
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund