HomeMy WebLinkAbout236799 09/10/14 (9,
CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%I-RQK AMOUNT: S*******188.00*
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 236799
CHICAGO IL 60677-7001 CHECK DATE: 09/10/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 393001 188.00 MEDICAL FEES
Community Occupational Health Svs
Purchase _II 7169 Solution Center
Description HCl 1����lio Chicago, IL 60677-7001
P.O'# P or F /P S>` )Phone: 317-621-0341
FEIN: 35-1955223
G.L.# 1- 3 O 7O0 = -pose -----
r - 7AUG
ID
Line et
iri��e�escr J / � 9 2��4
Purchaser DateAt3prova �11VOICe ---�::
August 14, 2014
Bill to: Lynn Russell For: Cannel Clay Parks & Recreation
Carmel Clay Parks & Recreation 08/14
1411 E. 116th St.
Cannel, IN 46032-
.. ......................... ... ... ... �.._.._.._...... .. ..._...._......._.._._..v..... ... .. ........_....__.._._......... ........._�......... __.... ............._.�....................... ....
Invoice# 393001
Proc Code Date Description Qty Charge Receipt Adjust Balance
746404 08/07/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Matthew T Anderson Balance Due: 5 47.00
746404 08/07/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Maria Awad Balance Due: 5 47.00
746404 08/01/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Josliva H Johnson Balance Due: 47.00
746404 08/01/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Maryann Oconnor Balance Due: S 47.00
Invoice# 393001 Balance Due: ,� 188.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and return with payment
--------------------------------------
oti.=
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
355031 Community Occupational Health Services Terms
7169 Solution Center
Chicago, IL 60677-7001
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
8/14/14 393001 Pre-employment drug testing $ 188.00
Total $ 188.00
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
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 188.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
Po#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1081-99 393001 4340700 $ 188.00 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
4-Sep 2014
Is 188.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund