HomeMy WebLinkAbout253022 1/11/16 9<G% 4�p''• CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH gklROK AMOUNT: S"•*"'"47.00'
s. _� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 253022
9.y;�TON �. CHICAGO IL 60677-7001 CHECK DATE: 01/11/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 439910 47.00 MEDICAL FEES
Voucher No. Warrant No.
i
355031 Community Occupational Health Service Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 47.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-99 439910 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
which charge is made were ordered and
received except
i
December 28, 2015
Signature
$ 47.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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ealth Svs
Commurnty Occu atlonal H itb
�y 7E1�69,Sol uian"Cehter''
Phone. 3 f7-621=0343
FEIN: 35-1955223
DEC 21 2015
BY: r[oce
Decemb�,eur�,�}15; 2015�,
Bill to: Lynn Russell For: Carmel Clay Parks &Recreation
Carmel Clay Parks &Recreation 12/15
1411 E. 116th St.
Carmel, IN 46032-
Inoj�ce-#Y44391.0� � }
61,
Proc Code Date Description Qty Charge Receipt Adjust Balance
746404 12/03/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Taryn M Ford Balance Due: 47.00
Invoice# 439910 Balance Due: 47:0.0
PLEASE REMIT PAYMENT PROMPTLY
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