HomeMy WebLinkAbout302092 08/22/16 1�"W q\F`
CITY OF CARMEL, INDIANA VENDOR: 355031
® it ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH(akjROK AMOUNT: $""
"'**"83.00"
r. ,� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 302092
9�'�TON�° CHICAGO IL 60677-7001 CHECK DATE: 08/22/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4341999 462022 83.00 OTHER PROFESSIONAL FE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
COMMUNITY OCCUPATIONAL HEALTH SERVI ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
7169 SOLUTION CENTER IN SUM OF$ 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.
$83.00 Payee
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police 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
462022 43-419.99 $83.00 1 hereby certify that the attached invoice(s),or 8/2/16 462022 drug/alcohol test Officer Martin $83.00
1110 101 1110 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
Monday,August 15,2016
Tim Green
Chief of Police
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
20Cost 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
August 02, 2016
Bill to: Jim Spelbring For: Carmel Police Department
Carmel Police Department 7/16
1 Civic Square
Cannel, IN 46032-
Invoice# 462022
Proc Code Date Description Qty Charge Receipt Adiust Balance
80101 07/16/2016 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 07/16/2016 Breath Alcohol Test 1.00 32.00 32.00
Brian A Martin XXX-XX-6703 Balance Due: 83.00
Invoice# 462022 Balance Due: 83.00
Please remit payment promptly