Loading...
HomeMy WebLinkAbout216073 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1 ONE CIVIC SQUARE HYLANT GROUP .� CARMEL, INDIANA 46032 P 0 BOX 40925 CHECK AMOUNT: $51,422.50 INDIANAPOLIS IN 46280-5000 CHECK NUMBER: 216073 CHECK DATE: 1/9/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 302 5023990 811899 28, 772 . 50 OTHER EXPENSES 302 5023990 811900 22 , 650 . 00 OTHER EXPENSES Eff Date, Trn Type.- Policy#. Description;,a Amount ' s,• INVOICE# 811900 01/01/12 CFE WC-S WCX002887 SERVICE FEE Citizens Ins Co of America $ 22,650.00 Invoice Balance: $ 22,650.00 Fy- 30 N 0 7 2013 1 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 Ris 1 i „ Eff Date,Trn Type Policy#. ;:; Description•; Amount,. t INVOICE# 811899 01/01/12 RIS WC-S WCX002887 WC PREMIUM Citizens Ins Co of America $ 28,772.50 Invoice Balance: $ 28,772.50 D Q � JAN 0 7 2013 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 • 40 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 HYLANT GROUP Purchase Order No. Terms Date Due Invoice Invoice' Description Amount Date Number (or note attached invoice(s) or bill(s)) 12/13/12 811899 Workers Compensation Policy RIS 28,772. 0 12/13/12 811900 Workers Compensation Policy CFE $22,650.00 Total $51,422.50 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 VOUCHER 1\19T/072013 WARRANT NO. ALLOWED 20 HYLANT GROUP IN SUM OF $ 301 Pennsylvania Parkway, Suite 201 Indianapolis, IN 46280 $ $151,422 50 ON ACCOUNT OF APPROPRIATION FOR 302 WORK COMP FUND 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 811899 302 $28,772.50 materials or services itemized thereon for 811900 S22 650 which charge is made were ordered and received except 20 r Sig ature Title Cost distribution ledger classification if claim paid motor vehicle highway fund