HomeMy WebLinkAbout258968 05/31/16 a`! CITY OF CARMEL, INDIANA VENDOR: 355031
® ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH�RVK AMOUNT: $*******21 1.00*
s �_� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 258968
v;�TON�/` CHICAGO IL 60677-7001 CHECK DATE: 05/31/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 453221 164.00 TESTING FEES
1201 4358800 455234 47.00 TESTING FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
COMMUNITY OCCUPATIONAL HEALTH SERVI ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
7169 SOLUTION CENTER IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
CHICAGO, IL 60677-7001 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$211.00 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Human Resources Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
453221 43-588.00 $164.00 1 hereby certify that the attached invoice(s),or 5/3/16 453221 $164.00
1201 101 1201 101
455234 43-588.00 $47.00 bill(s)is(are)true and correct and that the 5/13/16 455234 $47.00
1201 101 materials or services itemized thereon for 1201 101
which charge is made were ordered and
received except
Monday, May 23, 2016
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
Invoice
May 13, 2016
Bill to: Sue Coy For: Carmel Administration
Carmel Administration 05/16
1 Civic Square
Carmel, IN 46032-
Invoice# 455234
Proc Code Date Description QtV Charge Receipt Adjust Balance
80101 05/11/2016 NON-NIDA 5 Panel UDS 1.00 47.00 47.00
Kristopher C Anthis XXX-XX-3110 Balance Due: 47.00
Invoice# 455234 Balance Due: 47.00
PLEASE NOTE: Effective 6/1/16 there will be a fee increase for a select set of services -
:Q6rhmunity,Occupa.9rial Health Svs
7169 Solution Center
• : Chicago; 1� .60677-7001.
•
. .Phone: :817-621-'0341
FEIN: 35 1955223.
Invoice . .
Ma
y-03, 2016:
Bill to: : :Mark Cromhch; : : : For.: Carmel Fire•Department
.
Carmel.Fire Department _ : .04%16
1 Civic:Square
Carmel;W 46032-
Invoice# 453221. . .
Proc Code Date Description. : Charge Receipt : . : Adiust Balance
80101'.. .04/22/2016. Rap1d 5-Panel UDS 1.00. 51,00 51.00
82075 04/22/2016. •Breath Alcobol,Test. . : 1.00 . 31.00 31.00.: .'
Joaathan R.Benge XXX=XX=1044'B 'lance Due: 82.00..
80101. .' . 04/25/2016 Rapid;S:Panel UDS.... 1.00- 51:0.0 5.1,00
820.75 04/25/2016 .•Breath'Alcohol Test: 1:00.' 3.1:00 : : 3.1•.00
Neil RReeves.XXX•XX=6606:Balance Due:. 82.00
Invoice# 453223:Balance Due:' 164.00
PZEASE NOTE:Effective.6/1%16 there will be a fee increA.e'for A.seleet set.of services
Sumi ftd T.® . : . .
MAY 2 3. 2016
Clerk Treasurer: