HomeMy WebLinkAbout257855 04/26/16 1°�'C.IN:�I
�/ t� . CITY OF CARMEL, INDIANA VENDOR: 355031
j;® ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH gldkQK AMOUNT: $'"'•'`"82.00•
s. ,_� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 257855
9����N�� CHICAGO IL 60677-7001 CHECK DATE: 04/26/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 452091 82.00 TESTING FEES
VOUCHER NO. WARRANT NO.
ALLOWED 20
COMMUNITY OCCUPATIONAL HEALTH SERVI
7169 SOLUTION CENTER
IN SUM OF$
CHICAGO, IL 60677-7001
$82.00
ON ACCOUNT OF APPROPRIATION FOR
Human Resources
PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT
Board Members
452091 I 43-588.00 I $82.00 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
Tuesday,April 26, 2016
Cost distribution ledger classification if
claim paid motor vehicle highway fund
rescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
,n invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by
Thom, rates per day, number of hours, rate per hour, number of units,price per unit,etc.
Payee
Purchase Order No.
Terms
Date Due
ivoice Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
04/20/16 I 452091 I I $82.00
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
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
Invoice
April 20, 2016
Bill to: Jim Spelbring For: Carmel Fire Department
Carmel Fire Department 04/16
1 Civic Square
Carmel, IN 46032-
Invoice# 452091
Proc Code Date Description Qty Charge Receipt Adjust Balance
80101 04/09/2016 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 04/09/2016 Breath Alcohol Test 1.00 31.00 31.00
Chad M Utzig XXX-XX-1879 Balance Due: 82.00
Invoice# 452091 Balance Due: 82.00-
PLEASE
2.00-PLEASE REMIT PAYMENT PROMPTLY
Submitted To
APR 2.6 2016
Clerk Treasurer
Cut and return with navment