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HomeMy WebLinkAbout301654 08/08/16 y , CITY OF CARMEL, INDIANA VENDOR: 355031 !; 31 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH GIIROK AMOUNT: $*******141.00* s CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 301654 p�'�roiO' CHICAGO IL 60677-7001 CHECK DATE: 08/08/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 460843 94.00 MEDICAL FEES 1091 4340700 460843 47.00 MEDICAL FEES Voucher No. Warrant No. 355031 Community Occupational Health Services Allowed 20 7169 Solution Center Chicago, IL 60677-7001 In Sum of$ $ 141.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE /109 MCC PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1081-99 460843 4340700 $ 94.00 1 hereby certify that the attached invoice(s), or 1091 460843 4340700 $ 47.00 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 August 4, 2016 Signature $ 141.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 355031 Community Occupational Health Services Terms 7169 Solution Center Chicago, IL 60677-7001 Invoice Invoice Description Date Number (or note attached invoice(s)or bill(s)) PO# Amount 7/15/16 460843 Pre-Employment Drug Testing $ 94.00 7/15/16 460843 Pre-Employment Drug Testing $ 47.00 Total $ 141.00 1 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 ,� Com, i o "ityOccupationaL:Heal Sus 169 Solutio"?n Center Chicago, 4L-6Q677-70041 ���Phonec�`-317`62=1!=©3�1 FEIN: 35-1955223 RF,CEIVED JUL 2.0 7'016 In p:- > BY: ,Jul, ,15;201,6>. Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Cannel Clay Parks & Recreation 07/16 1411 E. 116th St. Carmel, IN 46032- . . .. . ...__.._... ...-..- l�nvoic�, e# ,460:843 Proc Code ICD Date Description Qty Charge Receipt Adjust Balance 746404 07/07/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Vanessa G Jimenez Balance Due: 47.00 746404 1) 07/08/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 S70.912A 2) S43.401 A Holly E Perlin-Grubb Balance Due: 47.00 746404 07/07/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Avery M Simmons Balance Due: 47.00 flnoice#4.60843 Balanee,D'ue:" t ai niin - - Please remit payment promptly -21 Ci-) _ } Cut and return with payment