212247 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
ONE CIVIC SQUARE HYLANT GROUP
CARMEL, INDIANA 46032 P 0 Box 40925 CHECK AMOUNT: $7,634.00
INDIANAPOLIS IN 46082-0910 CHECK NUMBER: 212247
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 802086 7, 634 . 00 GENERAL INSURANCE
��° ��Eff�Date,�Trn Type�Policy�# �� �<%�� '`� ��� zDescriptionf�� "17C
INVOICE ti 802086
01/01/12 +EN PCKG 1-16 3 0 5 8 1M4076TIL12 AMEND PROP SCH Travelers Insurance Companies $ 8,209.00
ADD INDIANA DESIGN CENTER GARAGE-ALLOCATE PREM:CRC$1,478
ADD CARMEL C, CENTER GARAGE-ALLOCATE PREM:CRC$6,156
+ADD WAVELOCH FLOW R - TRAL PARK AQUATICS CEN-I ER)ALLOC
?sN �� ATE PREM:PARKS DE .S575
�— vl Invoice Balance: $ 8,209.00
A11Y, 2 7 2012
By
301 Pennsylvania Parkway • Suite 201 • P.O.Box 40925 • Indianapolis,IN 46280-0925
Toll Free: 800-678-0361 Local: 317-817-5000 • Fax:317-817-5151
fits-
41 C
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))
08/22/12 802086 $7,634.00
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
Hylant Group
IN SUM OF $
301 Pennsylvania Parkway, Suite 201
Indianapolis, IN 46280-0925
$7,634.00
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 802086 43-475.00 $7,634.00 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, August 27, 2012
i
Director, Ad/ministration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund