HomeMy WebLinkAbout256103 03/04/16 ('�`p4•. CITY OF CARMEL, INDIANA VENDOR: 355031
�• ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH(UR4K AMOUNT: $*******141.00'
r ?a CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 256103
CHICAGO IL 60677-7001 CHECK DATE: 03/04/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 445650 141.00 MEDICAL FEES
Voucher No. Warrant No. !
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355031 Community Occupational Health Servi�es Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 141.00 i
ON ACCOUNT OF APPROPRIATION FOR
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108 ESE
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PO#or INVOICE NO. ACCT#/TITLE AMOUNT I Board Members
Dept#
1081-99 445650 4340700 $ 141.00 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
i received except
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February 22, 2016
1
Signature
$ 141.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
1
CoppmnityrOccuptio�al3Health�Su�s'
71.69$olution Center
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agog IL 60�67�7c=70Q1
10
Phone 317 62�i1 41
FEIN: 35-1955223
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Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Cannel Clay Parks &Recreation 02/16
1411 E. 116th St.
Cannel, IN 46032-
Ifivotce"�# 4"4�6��
Proc Code Date Description QtV Charge Receipt Adiust Balance
746404 02/11/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Lesley A Bonds Balance Due: 47.00
746404 02/04/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Shea Hurst Balance Due: 47.00
746404 02/11/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Logan S Niccum Balance Due: 47.00
Inuoice# 445650 Balance Due: 1r4+100
PLEASE REMIT PAYMENT PROMPTLY
Purchase
Description
P.O.# PorF
G.L.#
Budget
Lina Descr
Purchaser Date
Approval Date