HomeMy WebLinkAbout217096 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 366934 Page 1 of 1
ONE CIVIC SQUARE WILLIAM COLLINS
CHECK AMOUNT: $300.00
CARMEL, INDIANA 46032 17214 MEGGS
_off io NOBLESVILLE IN 46060 CHECK NUMBER: 217096
CHECK DATE: 2113/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 020513 300 . 00 OTHER EXPENSES
City of Carmel Employee Health Benefit Plan
Health Savings Account Incentive
The retired plan participant listed below has elected Plan A for 2013 and is eligible for a bi-
annual contribution to his or her HSA account, as authorized by Resolution BPW-10-03-12-02.
Please return check to Human Resources for further processing.
Plan Participant/Payee:
William Collins
17214 Meggs
Noblesville, IN 46060
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: February 5, 2013
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
William Collins Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
02K)5/1 3 02.05.13 Health Savings Aceaunt Incentive $300.00
Total $300.00
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
�IVI1-� 9�IlnS IN SUM OF $
17214 Megns
ni�hio�„�iio inl nanan
$$3nn nn
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Fi ind
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
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund