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HomeMy WebLinkAbout300054 07/12/16 i +of_CAgy / �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