HomeMy WebLinkAbout300054 07/12/16 i
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/ �F. CITY OF CARMEL, INDIANA VENDOR: 355031
® ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%IIAOK AMOUNT: $*******196.00*
r. e�; CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 300054
9.y,�roN ca CHICAGO IL 60677-7001 CHECK DATE: 07/12/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4239099 457913 196.00 OTHER MISCELLANOUS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
COMMUNITY OCCUPATIONAL HEALTH SERVI ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
7169 SOLUTION CENTER IN SUM OF$ 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.
$196.00 Payee
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Street Department 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
457913 42-390.99 $196.00 1 hereby certify that the attached invoice(s),or 6/15/16 457913 $196.00
2201 201 2201 201
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
Wednesday,June 29, 2016
Dave Huffman
Director
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
June 15, 2016
Bill to: Jim Spelbring For: Carmel Street Dept.
Carmel Street Dept. 06/16
1 Civic Square
Carmel, IN 46032-
Invoice# 457913
Proc Code Date Description Qty Charge Receipt Adjust Balance
06/03/2016 Respirator Fit Test 1.00 49.00 49.00
Evie M Anderson XXX-XX-7323 Balance Due: 49.00
06/03/2016 Respirator Fit Test 1.00 49.00 49.00
Lynette A Hobbs XXX-XX-2503 Balance Due: 49.00
06/03/2016 Respirator Fit Test 1.00 49.00 49.00
Brandon N Spelbring XXX-XX-2114 Balance Due: 49.00
_...._ ...... ...... _..... ................ ......... _
06/03/2016 Respirator Fit Test 1.00 49.00 49.00
Christopher A Stubbs XXX-XX-1295 Balance Due: 49.00
............. ............... .............................-. . _._._................... ......... ._...... ...........
Invoice# 457913 Balance Due: 196.00
PLEASE NOTE: Effective 6/1/16 there will be a fee increase for a select set of services