HomeMy WebLinkAbout220648 06/04/2013 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
ONE CIVIC SQUARE HYLANT GROUP
CARMEL, INDIANA 46032 P 0 BOX 40925 CHECK AMOUNT: $28,772.50
INDIANAPOLIS IN 46280-5000 CHECK NUMBER: 220648
CHECK DATE: 6/4/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
302 5023990 3689 28, 772 . 50 OTHER EXPENSES
Hylant-Indianapolis Invoice # 3689
04 H301 jj ANT Pennsylvania Parkway,Suite 201
Y j� j.\j Indianapolis,IN 46280 Date Balance Due On
P-(800)678-0361 5/22/2013 6113/2013
hylant.com F-(317)817-5151 Insured
City of Carmel
_ � 7 Account Number ;-� :' Amount Due
CARMELO-02 $28,772.50
City of Carmel
Attn: STEVE ENGELKING
One Civic Square
Carmel, IN 46032
Please Return Top with Remittance To: 301 Pennsylvania Parkway,Suite 201,Indianapolis,IN 462800925
Item-* Trans Eff Date:: Due Dafe Trans> ,•. Description— =• Amount
ms;µ
Worker's Compensation Policy# WCX002887 Effective: 1/1/12 - 1/1114
16613 1/1/2012 6/13/2013 RENB WC Premium 28,772.50
Total Invoice Balance: $28,772.50
D
JUN 0 3 2013
By
Ab' HYLANT Hylant-Indianapolis 301 Pennsylvania Parkway,Suite 201 Indianapolis IN 46280
5/22/201 Insured City of Carmel Loan# Invoice# 3689 UBAMAI Page 1 of 1
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))
05/22/13 3689 Workers Compensation Policy WCX002887 $28,772.50
Total $28,772.50
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 NOo _WARRANT NO.
ALLOWED 20
HYI AQII GR011 IP IN SUM OF $
301 Pennsylvania Parkway, Suite 201
Indianapolis IN 46280
$ -$28,77-2.5-0
ON ACCOUNT OF APPROPRIATION FOR
302 WORK CAMP 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
$28,772.50 materials or services itemized thereon for
which charge is made were ordered and
received except
20
�
-
. n
t Si n at
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund