HomeMy WebLinkAbout217118 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 079900 Page 1 of 1
ONE CIVIC SQUARE GARY DUFEK CHECK AMOUNT: $300.00
CARMEL, INDIANA 46032 12610 OVERTURE DRIVE
CARMEL IN 46033 CHECK NUMBER: 217118
CHECK DATE: 2/13/2013
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:
Gary Dufek
12610 Overture Drive
Carmel, IN 46033
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
Gary Dufek Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
02ffl5i!3 02-eEi-i3 Health Savings Aecount 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.
OTi T7TT-
ALLOWED 20
Gapy Dwfek — IN SUM OF $
12610 0vertl lre Ilr�ye
(Q Prmpl INI 46013
$ s3nn nn
ON ACCOUNT OF APPROPRIATION FOR
201 Mp—di(-al 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
Title
Cost distribution ledger classification if
1 claim paid motor vehicle highway fund