255733 03/01/16 (9,
CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%tIRQK AMOUNT: $********47.00*
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 255733
CHICAGO IL 60677-7001 CHECK DATE: 03/01/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 443627 47.00 TESTING FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
Invoice
February 02, 2016
Bill to: Jim Spellbring For: Carmel Police Department
Carmel Police Department 01/16
1 Civic Square
Carmel,IN 46032-
Invoice# 443627
Proc Code Date Description Qty_ Charge Receipt Adiust Balance
80101 01/16/2016 NON-NIDA 5 Panel UDS 1.00 47.00 47.00
Mark Paris XXX-XX-2668 Balance Due: 47.00
Invoice# 443627 Balance Due: 47.00
PLEASE REMIT PAYMENT PROMPTLY
Submifted To
FEB 1 2016
Clerk Treasurer
Cut and return with payment - -
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Please remit 47.00 to Community Occupational Health Services
7169 Solution Center
Please place invoice number 443627 on check Chicago,IL 60677-7001
Phone: 317-621-0341
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))
02/02/16 443627 $47.00
1201 101
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
COMMUNITY OCCUPATIONAL HEALTH SERVI
7169 SOLUTION CENTER IN SUM OF$
CHICAGO, IL 60677-7001
$47.00
ON ACCOUNT OF APPROPRIATION FOR
Human Resources
PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members
443627 I 43-588.00 I $47.00; 1 hereby certify that the attached invoice(s), or
1201 101
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
Monday, February 15, 2016
Cost distribution ledger classification if,
claim paid motor vehicle highway fund