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Home My WebLink About207772 04/10/2012 CITY OF CARMEL, INDIANA VENDOR: L2367 Page 1 of 1 ONE CIVIC SQUARE CARMEL CLAY PARKS -MONON CENTEF CHECK AMOUNT: $398.75 CARMEL, INDIANA 46032 C/O AUDREY KOSTRZEWA CHECK NUMBER: 207772 CHECK DATE: 4/10/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 R4341980 21668 2012 -133 398.75 WELLNESS PROGRAM Carmel o Clay env ®ice Parks &Recreation Date Invoice 1411 E 116th Street Carmel, IN 46032 3/23/2012 2012 -133 Bill To City of Carmel One Civic Square Carmel, IN 46032 Due Date 4/23/2012 Quantity Description Rate Amount For March 23, 2012 Pay Date 43 Adult Pass (City of Carmel) 12.93 555.99 5 Youth or Senior Pass (City of Carmel) 8.50 42.50 34 Household Pass (City of Carmel) 35.08 1,192.72 D Q APR 09 2012 By Remit to: Carmel Clay Parks Recreation Total Due 1411 E. 116th St. $1,791.21 Carmel, IN 46032 Questions? 317 573 -4025 Payment due 30 days from invoice date. corppass @carmelclayparks.com Please return a copy of invoice with payment. 09.23.11 (PR1119) Monon Center Reconcilliation Clry P M n Ca t Pun DlXnnnw In Clry and MPnon Pnnn Name Payroll Membership C.. Employee C" Tot al Due ce r count EffectNe Data T Las! Name Name Pass 7 131.111 l P Adult WWSen ype A, ors HH We Y Y HH A ns HH Alvey Rick 7/212010 Household +'1. 28.08 7.02 J 39 Alvey__IRick Household $35.08 1 $0,00 0 0 0 Among Janet 3/11/2011 Adult /Youth .1 1'r"i 17.14 4.28 2 1_431 I Arrlone (Janet Adult, Youth $21.43 1 1 _$0.00 0 0 o Barnes Davd 12/28/2011 Senor /Adult ,Q 1 6.80 1. 70 0.501 Barnes 1 Dav id Senior $8.50 1 $0.00 0 C 0 Beck Micah 7/14 /2011 Adult r t x 10.34 2.58 _12.93 Bec Micah Adult $12 .93 1 $0.00 0 0 0 chard, Jim 8/8/2007 Household i`�:x.i 28.08 7.02 1 35.081 Blanchard James House $35.08 f $0.00 Blan 0 0 Brant Kenneth 2/12/2010 Household �7�' 28.06 7.02 _3 5.08 Brant Ken neth Household $35.08 1 $0.00 0 0 0 Breedlove K. Michelle 8/17/2011 Household p 1 1 28.08 7_02 35_08 Breedlove K. Michelle Household $35.08 1 $0.00 0 0 0 Callahan Mark 1/21/2071 Household }j 1 28_06_ 7_02 35.08 Callahan Mark Household $35.08 1 $0.00 0 0 0 Carter Mark 2/10/2012 Household y..__'1 28.06 7.02 35.08 Carter Mark Adult, Youth $35.08 1 $0,00 0 0 0 Carter, Ron 4/11/2008 Senior /Adult 1N'' 17.14 4.29 21.0 Carter Ron Senior /Ad $21.43 1 1 1 $0.00 0 0 Coffey T 2/17/2012 Adult ,K1 ,Sr- 10.34 2,59 12.93 [Coffey Tim Adult 12.93 1 $0.00 0 0 Coo Jeffer 8/4/2010 Household {st A 28.08 7.02 35.08 Cooper Jeffrey Household $35.08 1 $0.00 0 0 0 Cox, Justin 10/912009 Household .rs 1. 28.06 7.02 35. 08 Cox Justin House hold $35.08 1 1 $0.00 0 0 0 Coy Sue 8/6/2007 Atlult 10.34 2.59_( 12.93 Coy Susan Househ $12.93 1 $0.00 C 0 0 Daley Penny 12/17/2010 AdulUAd It ^2 y 20.89 15 25.86 Daley Penny Adult, Adult $25.88 2 S0.00 0 o Days Wllam 3/14/2011 Household c; 1 28.06 7.02 35.08 D avis William Household $35.08 I 1 $0.00 0 0 0 Dawson, Greg 11/14/2011 Adult /Youth 1' 1.} 17.14 4,29 21 A7 Dawson Gregory_ Adult, Vouth $21.43 1 1 50.00 0 Deilsch, Marc 2/12/2010 Household S 3,y,t 28.08 7.02 35.08 Deitsch Marc Household $35.08 f 50.00_ o 0 o ,t DietA Aaron 8/8/2008 Adult 1'7,,,, 10.34 2.SB 12.93 _Dietz Aamn Adult $12.93 1 50.00 0 0 0 Drake Carl 5/9/2008 Adult 3 1 Y F 10.38 2.SB 72.93 Drake Cad Adult $12.93 1 50.00 0 0 Duffy John 17/12/2010 Househo 1 28.08 7.02 35 1Duffy John Household $35.08 1 50.00 0 0 0 Epp Greg 12/2/2011 Adult ki�4,J. 10.34 2.SB 12.93 Epp_ Greg Adu lt $12.93 $0.00 0 0 0 Fag Timoth 1/28/2011 10.34 2.5B L 12.93 Fa9in Timoth Adult $12.93 1 F' 00", Faucets Joseph 8/27/2010 Household 1 28. 7.02 35.08 Feucelt Joseph Householtl $35.08 1 o 0 0 Gilbert William 3/14/2008 Adult /Adult r21�, a 2069 15.17 25.86 Gilbert William Adult $25.86 1 2 o G Gi son pson Bruce 8!7/2011 Household 28.06 7.02 35.08 p_Bruce Household $35.08 1 0 0 0 Green T 8/9/2011 Household 28.06 7,02 35.08 G reen Tim Hou s ehold $35.08 1 $0.00 0 0 0 Gr T 9/14/2007 Household l�. X 11 28.06 7.02 35.08 Tim Household 1 $35.08 $0,00 0 0 0 Griffiths Pam 8/8/2007 Household ,A 1' 28,06 17.02 35.08 Griffiths Pamela Household $35.08 l 1 $0.00 0 0 0 Ganes, Jeff 8/9 /2010 Adult :t. Z; 10.34 2.59 12.03 Grimes Jeff_ Adult $12.93 1 50.00 0 0 0 Harrington Michelle 3/14/2011 Household �1 28.08 7.02 35.08 Harrington Michelle Household $35.08 1 1 $0.00 0 0 0 Heck, Nanc 2/2412011 Household q,± 3' 1 28.06 7.02 35.08 Heck Nancy I Household $35.08 1 $0.00 o o 0 Hicks Jaffre 1/2/2008 Adult/Ad Il 2 20.89 5.17 25 ,88 Hicks Jeff I Adult, Adult 1 $25.86 2 $0.00 o 0 o Hollander Gre 2/1212010 Adult/Ad It 2 20.88 5.17 25.8 Hollander Greg_ Adult, Adult $25.88 2 $0.00 0 0 0 Holt bau gh Michael 7/8/2007 Household 't 1 28.06 7.02 35.08 H011ibaugh Micha Household $35.08 1 $0.00 0 a 0 Keeling, Adrene 7/13/2011 Adult 10.34 2.59 12.93L (Keeling_ Adrienne Adult $12.93 1 50.00 o o Kirby, Kurt 1/13/2011 Household '1' 30.00 5.08 1 35.08 Kirb Kurt Household $35.08 1 $0.00 0 0 0 Lafollette, Sall 6/812007 Household 1 28.06 7.02 35.08 La Follette Gary Household $35.08 1 $0.00 Little johh, David 1/27/2012 Adult 110 10.34 2.59 12.83 Littlejohn David Adult $12.93 1 $0.00 0 0 0 Locke, Robert 6 /812007 Household 5 ..1 28.08 7.02 35.08 Locke Robert Household $35.08 50.00 0 0 0 taper Michael 3/14/2008 Adult 10.34 2.59 12.931 Luperll Michael Adult $12.93 1 $0.00 0 0 0 Maki, Sue 1117/2011 Adult it 10.34 2.59 12.031 Maki Suzanne Adult $12.93 1 $0.00 0 0 0 Marsh, Michael 10/25/2011 Adult 10.34 2.59 12.931 Marsh Michael Adult $12.93 1 0.00 0 0 Mascari, John 10/12/2007 Adult 't,: 10.34 2.59 12.93 Mascar John Adult $12.93 1 $000 o o o Massingill, Randy 9/12/2008 Adult�` 10.34 2.59 12.93 Massin9ill Randy Adult $12.93 1 $0.00 Mast, Darren 7/6/2007 Adult 1?''r°" 10.34 2.59 11.93 Mast Darren Adult $12.93 1 $0.00 0 0 0 McCoy, David 11/14/2011 Household 1 28.06 7.02 35.08 McCoy David Household $35.06 $0.00 0 o o McNab, John 7/2/2009 Adult !.ix 10.34 2 12.93 MCNab John Adult $12.93 1 $0.00 0 0 0 Miller, Adam 7/8/2007 Adult '.1' 10.34 2.59 1 12.93 Miller Adam Adult $12.93 1 1 $0.00 0 0 0 Miller, Ken 8/23/2010 Senior /Adult 7y. °.7�'y., 17.18 4.29 21,43 Miller Ken Senior/Adult $21.43 1 $0.00 0 0 Mshlar N 8/3/2010 Household 1._ 28.08 7.02 35.08 Mishler Nick Household $35.08 1 $0.00 0 0 0 Morgan Trent 1/15/2010 Adult 10.34 2.59 12.93 Morgan Trent Adult $12.93 $0.00 0 0 0 My ers, Brad 12/1/2008 Household 1 28.06 7.02 35.08 Myers Brady Household $35.08 1 S0.00 0 0 0 Neville, Katie 1/15/2010 Adult I l l 10.34 2.59 12.93 Neville Katie Adult $12.93 f 50.00 0 0 0 Orange Doug 10/10/2008 Adult .ice 10.34 2.59 12.93 Orang Dou Adult $12.93 $0.00 0 0 0 Pattyn Dawn 8/8/2007 Household ,a 28.08 7.02 35.08 Pattyn Household $35.08 1 $0.00 0 o P Libb 812312011 Adult '_7 r 10.34 2.58 12.93 Pickett Libby Adult $12.93 1 $0.00 C o o P'lm an Michael 2/12/2010 Household ",t 28.06 7.02 35.08 Pdman Michael Household $35.08 1 $0.00 0 o 0 Platt, Jaca 8/8/2007 Adult 1.- 10.34 2.58 1203 _Platt Jace Adult $12.93 1 $0.00 0 0 0 Rhodes, Kenneth 8/8/2007 Adult/Adult 2 o 20.88 5.17 25.88 Rhodes Kenneth Adult, Adult $25.88 2 $0,00 0 0 Rider, Kevin 2/1 /2008 Adult/Adult 20.69 5.17 25.86 Rider Kevin Adult, Adult $25.88 2 $0.00 0 0 0 Schriner, Adam 1/2/2009 Household 28.06 7.02 35,08 Schriner Adam Household $35.08 1 $0.00 0 0 0 Sharp, Rick 10/10/2008 Household "..7 28.08 7.02 3588 Sharp Rick Household $35.08 1 $0.00 C o Smith, Jerr 2/1 /2008 Household .7 28.06 7.02 35408 Smiley Landry_ Household $35.08 f $0.00 0 0 0 Smiley Landry 1/15/2010 Household 1 28.08 7.02 35.08 Smith Jerry Household $35.08 1 $0.00 0 0 0 Steury, Kant 3/1/2009 Adult s,1.�r_° �y 10.34 2.59 12.03 Steury Kent Adult $12.93 1 $000 a o Thomas, John 7/3/2008 Household ,;s 7 28,06 7.02 35.08 Thomas John Household $35.08 1 $0.00 0 0 Thordarson, Eric 10/25/2011 Adult Adult 2 c 20,68 5.17 25.86 Thordarson Erik Adult, Adult $25.88 2 $0.00 0 0 o Tierney. Scott 8/812007 Household ,1 28006 7.02 35.08 Tierney Scott Household $35.08 1 $0.00 0 o o Tolan, Brian 8129/2010 Adult -1 10.34 2.58 12.93 Tolan Brian Adult $12.93 i $O. DD o 0 Uta g, Chad 6/812007 Household „1 28.06 7.02 35.0 Utzig Chad Household $35.08 1 $0.00 Total Monthly $1,791:21_ 43 5 34 43 5 34 1434,87 358.54 1781.21 1405.9 J98.75 I 1791.21 SUNGARD PENTAMATION, INC. PAGE NUMBER: 175 DATE: 03/20/2012 CITY OF CARMEL MODULE NUM: PAYCHK43 TIME: 16:05:17 DEDUCTION REGISTER CHECK DATE 03/23/2012 PAY RUN 206 PR 1206 #6 2012 361 MONON CENTER PAYROLL DED EMPLOYEE EMPLOYER EMPLOYEE EMPLOYEE NAME---- SUBJECT WAGES ACCOUNT DEPARTMENT DEDUCTION CONTRIBUTION ARREARS 765 ALVEY RICHARD 1,721.94 1602 28.06 .00 .00 250 ARNONE JANET 2,026.26 1115 17.14 .00 .00 3744 BARNES DAVID 2,389.78 2200 6.80 .00 .00 1026 BECK MICAH 1,734.24 1601 10.34 .00 .00 120 BLANCHARD JAMES 3,197.15 1192 28.06 .00 .00 730 BRANT KENNETH 2,624.38 1120 28.06 .00 .00 2603 BREEDLOVE KAREN 1,526.98 1602 28.06 .00 .00 75 CALLAHAN MARK 3,226.59 1120 28.06 .00 .00 2364 CARTER MARK 1,751.38 2201 28.06 .00 .00 610 CARTER RONALD 620.00 1401 17.14 .00 .00 2285 COFFEY TIM 1,905.36 2201 10.34 .00 .00 456 COOPER JEFFREY 2,433.96 651 28.06 .00 .00 2336 COX JUSTIN 3,191.46 1120 28.06 .00 .00 809 COY SUSAN 2,201.08 1201 10.34 .00 .00 1046 DALEY PENNY 1,952.34 1602 20.68 .00 .00 2638 DAVIS WILLIAM 1,953.86 2201 28.06 .00 .00 217 DAWSON GREGORY 2,803.61 1110 1 7.14 .00 .00 954 DEITSCH MARC 3,276.44 1120 28.06 .00 .00 316 DIETZ AARON 3,417.35 1110 10.34 .00 .00 413 DRAKE CARL 2,979.36 1120 10.34 .00 .00 479 DUFFY JOHN 4,164.66 601 28.06 .00 .00 985 EPP GREGORY 1,745.00 1601 10.34 .00 .00 2164 FAGIN TIMOTHY 2,815.96 1120 10.34 .00 .00 278 FAUCETT JOSEPH 2,624.34 651 28.06 .00 .00 2354 GILBERT WILLIAM 2,330.53 1110 20.68 .00 .00 870 GIPSON BRUCE 3,472.96 1120 28.06 .00 .00 39 GREEN TIMOTHY 4,199.26 1110 28.06 .00 .00 2167 GRIFFIN TIMOTHY 2,282.35 1120 28.06 .00 .00 2177 GRIFFITHS PAMELA 2,348.40 1202 28.06 .00 .00 566 GRIMES JEFFREY 2,645.92 1120 10.34 .00 .00 4766 HARRINGTON MICHELLE 1,240.00 1120 28.06 .00 .00 822 HECK NANCY 3,794.27 1203 28.06 .00 .00 1020 HICKS JEFFREY 1,922.40 2201 20.69 .00 .00 657 HOLLANDER GREGORY 2,665.65 1602 20.69 .00 .00 371 HOLLIBAUGH MICHAEL 4,156.20 1192 28.06 .00 .00 1015 KEELING ADRIENNE 2,592.58 1192 10.34 .00 .00 69 LAFOLLETTE SALLY 1,895.78 1120 28.06 .00 .00 2203 LITTLEJOHN DAVID 2,445.76 1192 10.34 .00 .00 619 LOCKE ROBERT 3,573.82 1110 28.06 .00 .00 2265 LUPER II MICHAEL 2,126.22 1602 10.34 .00 .00 2419 MAKI SUZANNE 2,547.96 601 10.34 .00 .00 568 MARSH MICHAEL 2,653.00 1120 10.34 .00 .00 2063 MASCARI JOHN 2,149.54 1602 10.34 .00 .00 841 MASSINGILL RANDY 2,059.84 1601 10.34 .00 .00 2286 MAST DARREN 2,132.61 1192 10.34 .00 .00 1057 MCCOY DAVID W. 2,209.98 1202 28.06 .00 .00 874 MCNAB JOHN 3,212.50 1120 10.34 .00 .00 575 MILLER ADAM 2,989.34 1110 11.08 .00 .00 3872 MILLER KEN 475.50 1207 17.14 .00 .00 3913 MISHLER NICHOLAS 1,636.96 1192 28.06 .00 .00 3846 MORGAN TRENT 1,521.17 1602 10.34 .00 .00 961 MYERS BRADY 3,708.96 1110 28.06 .00 .00 4326 NEVILLE KATHERINE 1,756.56 2200 10.34 .00 .00 2176 ORANGE DOUGLAS 2,282.35 1120 10.34 .00 .00 SUNGARD PENTAMATION, INC. PAGE NUMBER: 176 DATE: 03/20/2012 CITY OF CARMEL MODULE NUM: PAYCHK43 TIME: 16:05:17 DEDUCTION REGISTER CHECK DATE 03/23/2012 PAY RUN 206 PR 1206 #6 2012 361 MONON CENTER PAYROLL DED EMPLOYEE EMPLOYER EMPLOYEE EMPLOYEE NAME---- SUBJECT WAGES ACCOUNT DEPARTMENT DEDUCTION CONTRIBUTION ARREARS 817 PATTYN DAWN 1,683.46 1120 28.06 .00 .00 2113 PICKETT ELIZABETH 1,999.84 2200 10.34 .00 .00 962 PITMAN MICHAEL 2,529.53 1110 28.06 .00 .00 94 PLATT JACE 3,168.88 1120 10.34 .00 .00 2369 RHODES KENNETH 3,079.87 1602 20.69 .00 .00 3383 RIDER KEVIN 620.00 1401 20.69 .00 .00 1005 SCHRINER ADAM 2,849.04 1192 28.06 .00 .00 2140 SHARP RICHARD 620.00 1401 28.06 .00 .00 3450 SMILEY LANDRY 2,293.09 1110 28.06 .00 .00 2038 SMITH IV JERRY 2,357.46 1602 28.06 .00 .00 422 STEURY KENT 2,678.23 1120 10.34 .00 .00 2952 THOMAS JOHN 2,398.24 2200 28.06 .00 .00 4762 THORDARSON ERIK 2,533.15 1120 20.69 .00 .00 225 TIERNEY SCOTT 3,284.28 1120 2.8.06 .00 .00 2258 TOLAN BRIAN 2,806.14 1602 10.34 .00 .00 941 UTZIG CHAD 3,294.27 1120 28.06 .00 .00 TOTAL EMPLOYEES 70 171,507.33 1,405.39 .00 .00 Spelbring, James P HR From: Audrey Kostrzewa [audreyk @carmelclayparks.com] Sent: Tuesday, March 20, 2012 11:28 AM To: Spelbring, James P HR Subject: RE: MCC memberships /invoice Thanks, Jim. Audrey Kostrzewa Business Services Division Manager Carmel Clay Parks Recreation Administrative Offices 1411 E. 116th Street Carmel, IN 46032 P 317.573.4021 F 317.571.4136 audreyk @carmelclayparks.com www.carmelclayparks.com From: Spelbring, James P HR [mailto:jpspelbring @carmel.in.gov] Sent: Tuesday, March 20, 2012 11:27 AM To: Audrey Kostrzewa Subject: RE: MCC memberships /invoice Agreed. 1 will send this to you in addition to.the normal payment. Jim Spelbring Office Administrator City of Carmel Human Resources One Civic Square Carmel, IN 46032 PH: (317)571 -2467 FX: (317)571 -2409 jpspelbring @carmel.in.gov From: Audrey Kostrzewa [maiIto :audreyk @carmelclayparks.com] Sent: Tuesday, March 20, 2012 11:07 AM To: Spelbring, James P HR Subject: RE: MCC memberships /invoice Sorry, but I don't understand the $2.59 number you referenced. Adding another Adult Pass will add $12.93 to the total. The corrected breakdown for the 3/9/12 payday is as follows: 43 adults $12.93 555.99 5 youth /senior $8.50 42.50 34 households $35.08 $1,192.72 TOTAL $1,791.21 Payment already applied: $1,778.28 Leaving a balance of: 12.93 1 Agreed? Audrey Kostrzewa Business Services Division Manager Carmel Clay Parks Recreation Administrative Offices 1411 E. 116th Street Carmel, IN 46032 P 317.573.4021 F 317.571.4136 audreyk @carmelclayparks.com www.carmelclayparks.com From: Spelbring, James P HR mailto :jpspelbring(�Ocarmel.in.gov Sent: Tuesday, March 20, 2012 9:45 AM To: Audrey Kostrzewa Subject: RE: MCC memberships /invoice Looks like my sheet was missing Tim Coffey's pass information. The numbers I show are 43 Adult, 5 Youth /Senior, and 34 Household. Looks like we match now. I will use this email chain as documentation to get the additional $2.59 we owe you for the difference. This will come with the 03/26/12 check. My apologies for the confusion. From: Audrey Kostrzewa mailto :audreyk @carmelclayparks.com Sent: Monday, March 19, 2012 12:56 PM To: Spelbring, James P HR Subject: RE: MCC memberships /invoice I have all those changes but still don't match your numbers. You show 42 HH passes and I have 43. Please compare your list my the attached revised list and let me know which Household Pass member should be removed and cancelled. Thanks again, Audrey Kostrzewa Business Services Division Manager Carmel Clay Parks Recreation Administrative Offices 1411 E. 116th Street Carmel, IN 46032 P 317.573.4021 F 317.571.4136 audreyk @carmelclayparks.com www.carmelclayparks.com From: Spelbring, James P HR mailto :jpspelbring @carmel.in.gov Sent: Monday, March 19, 2012 11:46 AM To: Audrey Kostrzewa Subject: RE: MCC memberships /invoice Mark Carter changed from Adult Child to Household William Davis changed from Adult only to Household Sean Whitlow canceled his entire membership due to lack of use. 2 From: Audrey Kostrzewa mai Ito: audreyk @carmelclayparks.com Sent: Monday, March 19, 2012 9:39 AM To: Spelbring, James P HR Subject: FW: MCC memberships /invoice Jim, Please update me on the changes you made on the March 9 invoice, as it seems that our records to do not match. I need this information to properly post the payment and also to assure that future invoices /employee lists are accurate. Thanks, Audrey Kostrzewa Business Services Division Manager Carmel Clay Parks Recreation Administrative Offices 1411 E. 116th Street Carmel, IN 46032 P 317.573.4021 F 317.571.4136 audreyk @carmelclayparks.com www.carmelclayparks.com From: Audrey Kostrzewa Sent: Thursday, March 15, 2012 9:53 AM To: Spelbring, James P HR' Subject: MCC memberships /invoice Hi Jim, The City's check arrived today for payment of the MCC employee memberships for the 3/9/12 payday and all of the membership counts on our invoice were altered. I need you to provide the detail on the changes in each category. Please refer to the membership list that you received with the invoice and let me know what names /memberships have changed so I can adjust my list. It is important that our member lists match for each two -week period. Thanks, Audrey Kostrzewa Business Services Division Manager Carmel Clay Parks Recreation Administrative Offices 1411 E. 116th Street Carmel, IN 46032 P 317.573.4021 F 317.571.4136 audreyk @carmelclayparks.com www.carmelclayparks.com 3 VOUCHER NO. WARR NO. ALLOWED 20 Carmel Clay Parks and Recreation Monon Ce c/o Audrey Kostrzewa IN SUM OF 1411 E. 116th St. Carmel, IN 46032 $398.75 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 21668 2012 -133 43- 419.80 $398.75 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, April 09, 2012 Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 03/23/12 2012 -133 $398.75 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