HomeMy WebLinkAbout235377 7 /30/2014 9,J4 .�,\f` CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CUfVK AMOUNT: $********49.00*
CHICAGO CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 235377
9��f TOtl � CHICAGO IL 60677.7001 CHECK DATE: 07/30/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4239099 391373 49.00 OTHER MISCELLANOUS
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
Invoice
July 18, 2014
Bill to: Jim Spelbring For: Carmel Street Dept.
Carmel Street Dept. 7/14
1 Civic Square
Carmel, IN 46032-
Invoice# 391373
Proc Code Date Description Qty Charge Receipt Adjust Balance
07/16/2014 Respirator Fit Test 1.00 49.00 49.00
Jimmie W Kitterman XXX-XX- Balance Due: 49.00
Invoice# 391373 Balance Due: 49.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and return with payment
VOUCHER NO. WARRANT NO.
ALLOWED 20
Community Occupational Health Services
IN SUM OF$
7169 Solution Center
Chicago, IL 60677-7001
$49.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
2201 I 391373 I 42-390.991 $49.00 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
uaval0
' `2014
Street Gen III jissiu,jer
Street Commissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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.
i
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
07/18/14 391373 $49.00
I 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