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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