HomeMy WebLinkAbout303700 09/30/16 CITY OF CARMEL, INDIANA VENDOR: 355031
F ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH PabROK AMOUNT: $******"83.00•
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 303700
vy`roN, CHICAGO IL 60677-7001 CHECK DATE: 09/30/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 467478 83.00 TESTING FEES
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995)
COMMUNITY OCCUPATIONAL HEALTH SERVI ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
7169 SOLUTION CENTER IN SUM OF$ 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.
$83.00 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
467478 43-588.00 $83.00 1 hereby certify that the attached invoice(s),or 9/16/16 467478 $83.00
1201 101 1201 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,September 26, 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
1'Y FEIN: 35-1955223
Invoice
September 16, 2016
Bill to: Jim Spelbring For: Cannel Police Department
Cannel Police Department 09/16
1 Civic Square
Carmel, IN 46032-
Invoice# 467478
Proc Code Date Description Qty Char e Receipt Ad'ust Balance
80101 09/12/2016 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 09/12/2016 Breath Alcohol Test 1.00 32.00 32.00
Larry J Collins XXX-XX-3794 Balance Due: 83.00
Invoice# 467478 Balance Due: 83.00
Please remit payment promptly
Submitted To
SEP 2 6 2016
Clerk Treasurer
Cut and return with payment