HomeMy WebLinkAbout253609 01/22/16 �,ALf. CITY OF CARMEL, INDIANA VENDOR: 355031
® it ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%I8ROK AMOUNT: $********94.00*
=a CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 253609
v;��oN�` CHICAGO IL 60677-7001 CHECK DATE: 01/22/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 436037 47.00 TESTING FEES
1125 4340700 442269 47.00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
Invoice
November 03, 2015
Bill to: Jim Spellbring For: Carmel Fire Department
Carmel Fire Department 10115
1 Civic Square
Carmel, IN 46032-
Invoice# 436037
Proc Code ICD9 Date Description QtV Charge Receipt Adjust Balance
80101 1) 10/26/2015 NON-NIDA 5 Panel UDS 1.00 47.00 47.00
S33.8XXA
2)M54.32
Bradley D Marcum XXX-XX-5367 Balance Due: 47.00
Invoice# -43663f Balance Due: 47.00
PLEASE REMIT PAYMENT PROMPTLY
Submitted To
l
- JAN 19 2016
Clerk T reasurer
f`„r�„A,•Ai,,,,,„,irh„a,,,,,A„r
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 Date Invoice# Description Amount
Dept. Fund# (or note attached.invoice(s)or bill(s))
11/03/15 436037 $47:00
1201 101
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
COMMUNITY OCCUPATIONAL HEALTH SERVI
7169 SOLUTION CENTER IN SUM OF$
CHICAGO, IL 60677-7001
$47.00
ON ACCOUNT OF APPROPRIATION FOR
Human Resources
PO#/Dept. INVOICE NO. ACCT#/Fund I AMOUNT Board Members
436037 I 43-588.00 I $47.00' 1 hereby certify that the attached invoice(s), or
1201 101 Prior Year
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
Tuesday, January 19, 2016
'4
Cost distribution ledger classification if
claim paid motor vehicle highway fund
.va
Comm' unity�Occupational Healt..Svs
7169 uton Center
C�h1pago;�=, "'62 ^7 n
Pfa��ek°�31`��'1103
FEIN: 35-1955223° +
JAN 1 2016 II
BY:
Invoiceff�•�
1 an'uary'05 201°6;
Bill to: Lynn Russell For: Carmel Clay Parks &Recreation
Carmel Clay Parks &Recreation 12/15
1411 E. 116th St.
Carmel,IN 46032-
1442269
Proc Code Date' Description QQt Charge Receipt Adiust Balance
746404 12/31/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
3671638
Kylie N Martin Balance Due: 47.00
Invoice# 442269 Balance Due: MMKIROM
PLEASE REMIT PAYMENT PROMPTLY
ACCOUNTS PAYABLEVOUCHER
CITY OF CARMEL
An invoice of bill to be propprly 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
115116 442269- Pre-employment drug testing $ 47.00
Lr Total $ 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
i
Voucher No. Warrant No.
I
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
' Chicago, IL 60677-7001
In Sum of$
$ 47.00
4
a
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
y
Po or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept:#
1125 442269 4340700 $ 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
S which charge is made were ordered and
y received except
f
4
w January 14, 2016
1P.
I
Signature
$ 47.00 Accounts Payable Coordinator
Cost distribution ledger classification if { Title
claim paid motor vehicle highway fund