HomeMy WebLinkAbout169163 02/17/2009 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL
;''.•�,�a CARMEL, INDIANA 46032
EAP CHECK AMOUNT: $3,424.95
8401 HARCOURT ROAD CHECK NUMBER: 169163
INDIANAPOLIS IN 46260
CHECK DATE: 2/17/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 R4347500 16049 052880659 3,424.95 EAP SERVICE
r�
i
5r
J
ST VINCENT EMPL. ASST. PROGRAM
8401 HARCOURT RD
INDIANAPOLIS IN 46260 Date Account Number Balance
01/13/09 5- 20376299 3179.85
t
*CITY OF CARMEL
LAMB,BARB
CITY HALL 1 CIVIC SQUARE
CARMEL,IN 46032
Please enclose top portion with payment
Rate 2 15 Number of Employees: 4 s3
ACCT 5- 20376299 PATIENT: *CITYrOF CARMEL CHG AMT PAY /ADJ BALANCE
INVOICE 052622923
EMP PROVIDER
10/06/08 OCTOBER 2008 1059.95
10/06/08 NOVEMBER 2008 1059.95
10/06/08 DECEMBER 2008 1059.95
12/09/08 COMPANY PAYMENT 3179.85
INVOICE BALANCE: 0.00
INVOICE 052880659
EMP PROVIDER
01/08/09 JANUARY 2009 1)'4
01/08/09 FEBRUARY 2009 10- 5-9 -9 1 1 1 1
01/08/09 MARCH 2009 1 5 9-.
INVOICE BALANCE: 3
3 L4.1
Account 0 -30 days 31 -60 days 61 -90 days >90 days Balance Due
5- 20376299 3179.85 0.00 0.00 0.00 3179.85
PAGE: 1
ST VINCENT EMPL. ASST. M F 9a.m. to 4p.m.
8401 HARCOURT RD Ph: 317 338 -4900
INDIANAPOLIS IN 46260
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
St. Vincent EmPI Asst Program Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
0 1 /1 3/OE 05
$3,424.95
Total
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. WARRANT NO.
ALLOWED 20
-8t. Vincent Empl As Program
IN SUM OF
8401 Harcourt Road
Indianapol IN 46260
$3,424.95
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1205 Administration
Board Members
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
partial 052880659 4 75 $3 95 materials or services itemized thereon for
which charge is made were ordered and
received except
20
sign Z
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund