HomeMy WebLinkAbout233209 06/04/14 CITY OF CARMEL, INDIANA VENDOR: 355031
® iI ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH tldROK AMOUNT: $********47.00*
r° CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 233209
'M,iroN�o. CHICAGO IL 60677-7001 CHECK DATE: 06/04/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 05 . 15. 14 47.00 TESTING FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
�z�\ Phone: 317-621-0341
FEIN: 35-1955223
Invoice
May 15, 2014
Bill to: Jim Spellbring For: Carmel Police Department
Carmel Police Department 5/14
1 Civic Square
Carmel, IN 46032-
Invoice # 384937
Proc Code ICD9 Date Description QtV Charge Receipt Adjust Balance
30101 1)847.0 05/13/2014 NON-NIDA 5 Panel UDS 1.00 47.00 47.00
2) E819.0
Adam C Miller XXXA\-2163 Balance Due: 47.00
Invoice# 384937 Balance Due: 47.00
PLEASE REMIT PAYMENT PROMPTLY
Submitted To
JUN 022014
Clerk Treasurer
�i ❑7 witha 1ment
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
05/15/14 05.15.14 $47.00
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
VOUCHER NO. WARRANT NO.
Community Occupational Health Services ALLOWED 20
IN SUM OF $
7169 Solution Center
Chicago, IL 60677-7001
$47.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#lrITLE AMOUNT Board Members
1201 I 05.15.14 I 43-588.00 I $47.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, June 02, 2014
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund