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HomeMy WebLinkAbout228869 02/05/2014 CITY OF CARMEL, INDIANA VENDOR: 366934 Page 1 of 1 ONE CIVIC SQUARE WILLIAM COLLINS CARMEL, INDIANA 46032 651 DANIEL COURT CHECK AMOUNT: $400.00 ' WESTFIELD IN 46074 CHECK NUMBER: 228869 SON� CHECK DATE: 2/5/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 400 . 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 2014 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 651 Daniel Court Westfield, IN 46074 Amount: $400.00 Fund: Medical Escrow Fund (301) Date: February 3, 2014 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)) 400.00 0 Total 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 NW/03/14 WARRANT NO. ALLOWED 20 William Collins IN SUM OF $ 651 Daniel Court Westfield, IN 46074 $ $400.00 ON ACCOUNT OF APPROPRIATION FOR 301 Medical 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 02.03.14 301 $400.00 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