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Home My WebLink About304528 10/31/16 u'-4�p" CITY OF CARMEL, INDIANA VENDOR: 355031 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH QaIIROK AMOUNT: $""""466.00' f, /?� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 304528 ''��rtiri�°' CHICAGO IL 60677-7001 CHECK DATE: 10/31/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 464687 166.00 TESTING FEES 1110 4340701 469409 51.00 MEDICAL EXAM FEES 1201 4358800 470378 83.00 TESTING FEES 1201 4358800 470485 166.00 TESTING FEES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) COMMUNITY OCCUPATIONAL HEALTH SERVI ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 7169 SOLUTION CENTER IN SUM OF$ 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. $51.00 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# 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 469409 43-407.01 $51.00 1 hereby certify that the attached invoice(s),or 10/4/16 469409 blood draw-Devenport $51.00 1110 101 1110 101 bill(s)is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Thursday, October 13,2016 Tim Green Chief of Police I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 ,20 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice October 04, 2016 Bill to: Jiro Spelbring For: Carmel Police Department Carmel Police Department 09/16 1 Civic Square Cannel, IN 46032- Invoice# 469409 Proc Code Date Description QtV Charge Receipt Adjust Balance 80101 09/27/2016 Rapid 5 Panel UDS 1.00 51.00 51.00 Adam M Devenport XXX-XX-2255 Balance Due: 51.00 Invoice# 469409 Balance Due: 51.00 Please remit payment promptly _ - - . - - VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER COMMUNITY OCCUPATIONAL HEALTH SERVI 7169 SOLUTION CENTER IN SUM OF$ 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. $415.00 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 464687 43-588.00 $166.00 1 hereby certify that the attached invoice(s),or 9/2/16 464687 $166.00 1201 101 1201 101 470378 43-588.00 $83.00 bill(s)is(are)true and correct and that the 10/17/16 470485 $166.00 1201 101 materials or services itemized thereon for 1201 1 101 470485 43-588.00 $166.00 10/17/16 I 470378 I I $83.00 1201 101 which charge is made were ordered and 1201 101 received except Monday, October 24,2016 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 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 September 02, 2016 Bill to: Accounts Payable For: Carmel Fire Department City of Carmel 08/16 1 Civic Square Carmel, IN 46032- Invoice# 464687 Proc Code Date Description Q_yt Charge Receipt Adjust Balance 80101 08/11/2016 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 08/11/2016 Breath Alcohol Test 1.00 32.00 32.00 Donovan C Anderson XXX-XX-1540 Balance Due: 83.00 80101 08/07/2016 Rapid 5-Pan-el UDS 1.00 51.00 51.00 82075 08/07/2016 Breath Alcool Test 1.00 32.00 32.00 Gregory A Starr XXX-XX-6933 Balance Due: 83.00 Invoice# 464687 Balance Due: 166.00 Please remit payment promptly A . a mitted To FrT 2 4 2016 CIerk T re..as urer Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice October 17, 2016 Bill to: Jim Spelbring For: Carmel Civilian Cannel Utilities 10/16 1 Civic Square Carmel, IN 46032- Invoice# 470378 Proc Code Date Description QtV Charge Receipt Adjust Balance 80101 09/29/2016 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 09/29/2016 Breath Alcohol Test 1.00 32.00 32.00 Ronald Williams XXX-XX-2420 Balance Due: 83.00 Invoice#. 470378 Balance Due: 83.00 -Please-remit a hent promptly Mit e, T, OCT U 2 4 20166 Cut and return with payment Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice October 17, 2016 Bill to: Accounts Payable For: Carmel Fire Department City of Carmel 10/16 1 Civic Square Carmel, IN 46032- . . . _ _...___. . . ... . ..... Invoice# 470485 Proc Code Date Description Qty Charge Receipt Adjust Balance 80101 10/06/2016 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 10/06/2016 Breath Alcohol Test 1.00 32.00 32.00 Todd T Utzig XXX-XX-1967 Balance Due: 83.00 80101 10/07/2016 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 10/07/2016 Breath Alcohol Test 1.00 32.00 32.00 - - Kevin M Young-XXX-XX-7137 Balance Due:-- _ 83.00 Invoice# 470485 Balance Due: 166.00 Please remit payment promptly OCT 2 4 2016 Clark Tr- aSurer