FirstMartha
LastMcIntosh
Date02/02/2016
EmailEmail hidden; Javascript is required.
Phone(202) 363-9588
Make Check Payable toLiberty Mutual Insurance
Amount$2,746.00
Attach Receipt(s)
Mailing/Delivery Instructions

MUST BE POSTMARKED BY February 8, 2016!! Pay only the 1-21-2016 invoice. The other is included for reference and records. Also, see attached note about being over budget.\r\n\r\nMail to: Liberty Mutual Insurance, PO Box 9502, Dover, NH 03821-9502

PurposeInsurance

Operating expenses must be approved by an HSA Co-President. Committee-related expenses (e.g. Auction, Green Scene) must be approved by the committee chair. Resource teacher expenses must be approved by the Principal.
All receipts and/or supporting documents must be uploaded with or attached to this form.

For HSA Treasurer Only
Status of approval:
  • Approved