HomeMy WebLinkAbout228865 2/5/2014 �e. CITY OF CARMEL, INDIANA VENDOR: 358069 Page 1 of 1
ONE CIVIC SQUARE KIMBERLY BABB CHECK AMOUNT: $300.00
CARMEL, INDIANA 46032
CHECK NUMBER: 228865
CHECK DATE: 2/5/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 300 . 00 HSA CONTRIBUTION
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:
Kimberly Babb
14138 Shelborne Road
Westfield, IN 46074
Amount: $300.00
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
Kimberly Babb
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
^n1^'Jj4 A e2.03.14 Health Savings Afaeount 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.
VOUCH ER&Ma4 WARRANT NO.
ALLOWED 20
Kimberly Babb
IN SUM OF $
14138 Shelborne Road
Westfield, IN 46074
9300.00
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 $300.00 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