HomeMy WebLinkAbout216361 01/15/2013 CITY OF CARMEL, INDIANA VENDOR: 364990 Page 1 of 1
`. ONE CIVIC SQUARE C H C WELLNESS
CARMEL, INDIANA 46032 5440 N CUMBERLAND AVE#225 CHECK AMOUNT: $16,065.00
CHICAGO IL 60656
CHECK NUMBER: 216361
CHECK DATE: 1/15/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 26421 C2153 510 . 00 WELLNESS PROGRAM
1201 R4341980 26421 WL1357 2, 675 . 00 WELLNESS PROGRAM
1201 R4341980 26421 WP1798 12, 880 . 00 WELLNESS PROGRAM
5440 North. Cutxtberland Avent.te O'V®O C E
Suite # 225
Chicago, Illinois 60656 , (,'}i� Invoice c2153
Date 121G120I2
Ship 12!6/2012
Bill To Terms Net 30
City of Carmel Rep Ron
Atm: Barbara Lamb
I Civic Square I Due Date I;51'2013
Carmel,IN,=16032
Quantity Item Code Description Price Each Amount
3 H&\V-Company Health \ Wellness- Uninsured/Other Plan Participants 170.00 510.00
Ransford Brett
Schlcif Carolyn
Finkam Sue
Thank you for your business. Total Due: 5510.00
RLE,ASE_, MAKE CHECK PAYABLE TO: C.HC WELLNESS
REMITTANCE ADDRESS:
5440 NORTH CUMBERLAND AVE.
SUITE 225
CHICAGO, 1L 60656
5440 North Cumberland Avenue O lNj VO M E
Suite # 225
E �v
Chicago, Illinois 60656 Invoice# W111798^ ' ,"�
iE OF iININC, NEnE.iH
Date 12/13/2012
Ship 12/13/2012
Bill To Terms Net 30
City of Carmel
AWE Sue Wolfgang Rep Ron
1 CiN is Square Due Date 1 1/12/2013
Cannel, IN,46032
Quantity Item Code Description Price Each Amount
2013 Walking Program
184 \Valk Walking Program Participant Fee 70.00 12,880.00
74 Rped New Pedometers-No Charge(inclucled in the Fee) 0.00 0.00
36 Rped Replacement Pedometers-Complimentary(35%of the 0.00 0.00
1 11)repeat participants)
REVISED INVOICE `dotal Due: $12,880.00
PLEASE MAKE CHECK. PAYABLE TO: CI-1C WELLNESS
REMITTANCE ADDRESS:
5440 NORTH CU.MI3ERI-AND AVE.
SUITE 225
CHICAGO, IL 60656
5440 North Cumberland Avenue INVOICE
®®® Suite # 225 �\
Chicago, Illinois 60656 ,�,Q�� Invoice# WL1357
REDEEINING HEALiH ` �' Date 12/28/2012
Ship 12/28/2012
Bill To Terms Net 30
City of Cannel
Rep Ron
Attn: Sue Wolfgang
I Civic Square
Due Date 1/27/2013
Cannel, IN,46032
Quantity Item Code Description Price Each Amount
2013 Weight Loss Challenge:
2 WLCSF Weight Loss Challenge Set-up Fee 350.00 700.00
79 WLCPF Weight Loss Challenge Participant Fee 25.00 1,975.00
Thank you for your business. Total Due: $2,675.00
PLEASE MAKE CHECK PAYABLE TO: CHC WELLNESS
REMITTANCE ADDRESS:
5440 NORTH CUMBERLAND AVE.
SUITE 225
CHICAGO, IL 60656
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.
I
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
12/06/12 C2153 $510.00
12/13/12 WP1798 $12,880.00
12/28/12 WL1357 $2,675.00
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 NO. WARRANT NO.
ALLOWED 20
CHC Wellness
IN SUM OF $
5440 North Cumberland Avenue, Suite # 225
Chicago, IL 60656
$16,065.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Prior Year I hereby certify that the attached invoice(s), or
26421 C2153 43-419.80 $510.00
Prior Year bill(s) is (are)true and correct and that the
26421 WP1798 43-419.80 $12,880.00
Prior Year materials or services itemized thereon for
26421 WL1357 43-419.80 $2,675.00 which charge is made were ordered and
received except
Monday, January 14, 2013
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund