HomeMy WebLinkAbout2012-08-17 - ($346.06) - Check Register 12/08/1_'7-!.3:08 KITTPLAS COUNITY FY 20. 2 August 1 7 20 12 Page .1.
AP411 vozd Check Approval Re
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For the Fund / S�.i`� Fund 639 010 SNOQUALMIE PASS FIRE & RESC`JF;
Signature:
Batch 83.71'7 GL Period 8 from 98/01/7.2 to 08/al./I2 Bank GT, code 6 103.1110 ]ate 08/�17/1.2
Sheet fnvoice Type Uated Due Des cr 3.pLi.on PO Inv. Amo�int. Paid AmounL
Seg GL Code Les,c:rint-iorz :Crar.sactior� llescr.i.ption i,or.�l. Amount.
Check No. -191252577 9815L'J., 'sunpiiev.- D0072 A & M WF;T,J:JNG 346.06
Coi16!TertCs _=.3,ed Co 2ri60L'reCt vCndor
i. fl 2012AP42 I 081512 081..,1.2 SNOQiALM :: PASS FIRE & RES(-`"dr. 346.06 346.00
Batch 91-immal:v Local Amount
` DLal Invoices Reinstated 346.06
Total Holdbacks Reins;.,aced 0.00
Total Discounts 0.00
Net 34£.D6
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WARRANT DATE VENDOR N0. VENDOR NAfU�E WARRANT NO, DETACH AND RETAIN
0011512012 D0072 A& M WELDING 391252 577 FOR YOUR RECORDS,
INVOICE DATE DESCRIPTIONINV0ICE
INVOICE NO.
_AMOUNT
08/15/2012 SNOQUALMIE PASS FIRE & RESCUE $ 2012AP#2 $346.06
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TO TI IE TRI ASIJRER OF CRATE WARRANT NO. A AMOUNT
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KITT TAS COUNTY 08/1512012 391252577 X346.06
205 WEST FIFTH
ELLENSBURG,WASHINGTON 98926
. -. (509)562-7502
US SANK 639101096-671.
.............
1232
PAY ***Terse Hundred FO Collars And 06 Ce t�
To A & DING KfT7 NTY
The 2722 ND
Order FNUM A 98022 a .......
KiWtas C r
Of
II� 39L25257 ? 320Em ? L01: L53607394a01I�
12/OS/:!'7-_2:3'1 Ki:TFi:TAS COUNTY PY 2012. August 17 2012 Page 1
AP465 Check Regi.sCer Summary Format
Check Run Batch No. 81115 "Date 08/17/13
Amounts
Check Gross Discount Net
_141.252726 D0264 LIFE WtiSE 3466-06 346.06
Bank GL Code 639 197.117.6 346.05 346.06
Check (Regular) Issued 1 39fi.06 0.00 346,66
Direct Depo-sit :Issued 0 0.00 O.GU G,C0
Total Supplier Payments _ 1 34G.06 0.00 346.06
End of Check Register
Expense Voucher
Voucher# 08013 Kittitas County Page 93 of 20
Warrant# 08108/92
Department: KITTITAS COUNTY FIRE DISTRICT 5
Fund: EXPENSE FUND 2012 (639010)
Vendor: Ll-
LIFEWISE HEALTH PLAN OF WASHINGTON
PO BOX 91060
SEATTLE, WA 98111
Invoice Details: Account Details:
.. . ......
Number . . Date Purpose Amount Number Amount
522-10-11-01 346.06
122000000714 07118/12 346.06
Voucher Total 346.06 346,06
1 the undersigned do hereby certify under penalty of perjury that the materials have been furnished, the services
rendered or the labor performed as described herein and that the claim is a just, due and unpaid obligation against
the above-named governmental unit, and that I am authorized to authenticate and certify to said claim.
08/08/12
Signature Title Date
Cumulative Total 7,754.37 7,754.37
OFEWISE j � Direct Pay Bill
P.O.Box 91060 Invoice Date: 07/18/2012
Seatlle,WA 98111 Group No: 1000000
Invoice Number: 122000000714
Policyholder ID: 1 01 3961 49
CODE' Billing Period: JuIV 15 31, 2012
Vf i _: .
Customer Service Hours: Monday Friday 8 UU a.m to 5 OU p-rrt
DA - :Y Pulmo: 1-800-592.6804
TDD for the hearing impaired:800-842-5357 � VM
JEREMY 'I WISEMAN Payments online or By Phone: v,...:.�
PO BOX 99 Logon to your account at www3ifewisewa-com,or calf 1-888-431-2059.
SNOgUA.LMI E PASS, WA 98068, PloaseN21e:For quickest service by phone,please be prepared to enter
your Policyholder ID
Individual Health Care Coverage
^_
Description Pian Period ._—. Amount �—
Total Current Period Coverage PREFERRED July 15-31, 2012 ,$105.29
INDIVIDUAL DENTAL COPAY July 15. 31,2012 $17.21
Total Adjustments $0.00
Current Invoice Total $122.55
BALANCE DUE FROM PREVIOUS INVOICE $0.00
PAYMENT AND CREDITS POSTED SINCE PREVIOUS INVOICE $0.09
BALANCE FORWARD 50.99
PLEASE PAY"I'HIS AMOLIN
t toae wntc your Policyholder ID nwmbei on your chuck ano return with tl€e rematance coupon
in the envelope provided.
Members Covered on Current Billing Period: JEREMY WISEMAN
Welcome New Member! Thank you for entrusting your Health Care Coverage to LifeWise Health Plan of Washington.
Your ID card and welcome kit is sent under separate cover. If you do not receive it in the next few days, please notify us.
Payments received after the Invoice Date will be reflected on your next Statement.
Please Indicate any address changes on your coupon when you send your payment_Keep the upper portion for your records. 009931(11-2005)
Direct Pay Bill
.a.Box 91060 Invoice Date: 07/18/2012
seattie,WA 98111 Group No: 1000000
Invoice dumber: 122000000715
Policyholder ID; 101396149
Billing Period: August 01 - 31, 2012
Fray tent DUe,Date 8/ 12Ct2
Vit'.t�... . _
Customer servico Fours: moaday . E day 8-00 a to 600 p.rrt
Phone:1 800-602-6804
CODE: ;aW •m� = g.w�� TDD for the hearing impaired:800-842-5357
JEREMY J WISEMAN Payments Online or By phone:
Po BOX 99 VI I): Logan to your accou€ata€www.lilewiSeWZ.com.or call 1-888-431-2059.
s ote:Fnr gulckest service by phone.please be prepared to enter
S oQUALI�IIE PASS, WA 9 8 0 6 8
your Policyholder ID
Individual Health Care Coverage
Description Plan Period Amount
Total Current Period Coverage PREFERRED August 01 - 31, 2012 $192,00
INDIVIDUAL DENTAL COPAY August 01 -31,2012 $31.50
Total Adjustments $0.00
Current Invoice Total 5223.50
BALANCE DUE FROM PREVIOUS INVOICE $122.56
PAYMENT AND CREDITS POSTED SINCE PREVIOUS INVOICE $0.00
BALANCE FORWARD $122.56
W
;PLEA E PAY THIS AMOUNT.
f'{r:�zse W1 iw your Pohcyticidor U number on your check and return wiM the rernitttance coupon
in the envelope provided-
Members Covered on Current Sitting Period: JEREMY WISEMAN
Payments received after the Invoice Date wit[be reflected on your next Statement.
Please indicate any address changes on your coupon when you send your payment.Keep the upper portion for your records, pflgg3t(91-20 5}