HomeMy WebLinkAbout211112 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 362811 Page 1 of 1
s�0 ONE CIVIC SQUARE SCOTT LEBHERZ CHECK AMOUNT: $242.90
�a CARMEL, INDIANA 46032 755 COLLEGE WAY
CARMEL IN 46032 CHECK NUMBER: 211112
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 242 . 90 OTHER EXPENSES
S
� I
CITY°rc ARMEL
JAMES BRAINARD, .MAYOR
July 16, 2012
Scott Lebherz
755 College Way
Carmel, IN 46032
RE: INV®ICE # 201101782 DOS 06/28/2011
Dear Mr. Lebherz:
Enclosed you will find a reimbursement check in the amount of$242.90.
On April 24, 2012 we received a check from GLA Collection Service in the amount of
$418.79 for Michael's ambulance transport on June 28, 2011. We filed a claim for the
ambulance run and Suburban Health insurance paid $335.03 on May 4, 2012. The
collection fee is $92.13 the amount of the refund is $242.90.
If you have any questions, please feel free to contact me at (317) 571-2604.
Sincerely,
Michelle T. Harrington
Billing Administrator
I
CARUNU. Fmr•. DEPARTMENT
STEVEN A. COUTs HEADQUARTERS
Two CMc SQUARE, CAjuki ., IN 46032 OPPicE 317.571.2600, FAx 317.571.2615
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
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))
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 NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
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
materials or services itemized thereon for
which charge is made were ordered and
received except
JUL 1,6 2
0
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund