HomeMy WebLinkAbout304919 11/09/16 y yr_C4Ab
�i \. CITY OF CARMEL, INDIANA VENDOR: 355031
I ,j ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%RROK AMOUNT: $"""*"'188.00"
9 ?�, CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 304919
M���oN�, CHICAGO IL 60677-7001 CHECK DATE: 11/09/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 470060 141.00 MEDICAL FEES
1125 4340700 470060 47.00 MEDICAL FEES
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 188.00
ON ACCOUNT OF APPROPRIATION FOR
101 General/108 ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 470060 4340700 $ 47.00 1 hereby certify that the attached invoice(s), or
1081-99 470060 4340700 $ 141.00 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
November 4, 2016
Signature
$ 188.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
;� Com"muhity..Occnupa„ tionai;Healff = vs
•=;:71'69:Sof utionw;Center
Chicago;IL;�60677�70Q:1
Phone: 317-621`0341"�`'
FEIN: 35-1955223
Invoice
Qctobeu� 72Oi1:6
Bill to: Lynn Russell For: Carmel Clay Parks &Recreation
Cannel Clay Parks &Recreation 10/16
1411 E. 116th St.
Cannel, IN 46032-
9, �
Proc Code Date Description Qty Charge Receipt Adiust Balance
746404 10/07/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Craig A Banning Balance Due: 47.00
746404 10/05/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Emma J Capuano Balance Due: 47.00
746404 10/01/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Kelsey A Kinnett Balance Due: 47.00
746404 10/05/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Alexis D Price Balance Due: 47.00
Please remit payment promptly