HomeMy WebLinkAbout214431 11/07/2012 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
ONE CIVIC SQUARE T VINCENT HOSPITAL CHECK AMOUNT: $2,761.50
CARMEL, INDIANA 46032 SP
8401 HARCOURT ROAD CHECK NUMBER: 214431
INDIANAPOLIS IN 46260
CHECK DATE: 11/7/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 057852020 2, 761 . 50 GENERAL INSURANCE
Please enclose top portion with payment
Rate : 1 . 75 Number of Employees : 526
ACCT # : 5-20376299 PATIENT: *CITY OF CARMEL. CHG AMT PAY/ADJ BALANCE
INVOICE # : 057852020
EMP PROVIDER
10/10/12 OCTOBER 2012 920 . 50
10/10/12 NOVEMBER 2012 920 . 50
10/10/12 DECEMBER 2012 920 . 50
INVOICE BALANCE: 2761 . 50
D �
0 2012
By
Account 0-30 days 31-60 days 61-90 days >90 days Balance Due
5-20376299 2761 . 50 0 . 00 0 . 00 0 . 00 2761 . 50
PAGE : 1
ST VINCENT EMPL. ASST. M - F 9a.m. to 4p. m.
8401 HARCOURT RD Ph: 317-338-4900
INDIANAPOLIS IN 46260
z r
VOUCHER NO. WARRANT NO.
I ALLOWED 20
St. Vincent Employee Assistance Program
IN SUM OF $
8401 Harcourt Rd
Indianapolis, IN 46260
$2,761.50
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Prior Year I hereby certify that the attached invoice(s), or
1205 057852020 43-475.00 $2,761.50
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, November 05, 2012
Director, Administration
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))
10/12/11 057852020 $2,761.50
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