HomeMy WebLinkAbout305408 11/28/16 ♦u�.C�Nh
CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTHQjRQK AMOUNT: $•'•*""'282.00•
9 CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 305408
CHICAGO IL 60677-7001 CHECK DATE: 11/28/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 471326 188.00 . MEDICAL FEES
1091 4340700 471326 47.00 MEDICAL FEES
1125 4340700 471326 47.00 MEDICAL FEES
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 282.00
ON ACCOUNT OF APPROPRIATION FOR
101 General /108 ESE /109 MCC
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1125 471326 4340700 $ 47.00 1 hereby certify that the attached invoice(s), or
1081-99 471326 4340700 $ 188.00 bill(s)is(are)true and correct and that the
1091 471326 4340700 $ 47.00 materials or services itemized thereon for
which charge is made were ordered and
received except
November 15, 2016
Signature
$ 282.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
C mmunityxOc pational Health.-
7Ai69 Sol lion=Cente "
Chlcago IL'w6067 E 00-1�.
Phone: 317-621-0341
FEIN: 35-1955223E-EIS- D
NOV 0
77 2016
BY:
Invoice
Xue�rlber.:02, 2016�
Bill to: Lynn Russell For: Carmel Clay Parks &Recreation
Carmel Clay Parks &Recreation 10/16
1411 E. 116th St.
Carmel, IN 46032-
Invoice✓#" .4,71326"� ;'
Proc Code ICD Date Description Qty Charge Receipt Adjust Balance
746404 10/26/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Nicole B Agnew Balance Due: 47.00
746404 10/12/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Jeffrey Edwards Balance Due: 47.00
746404 10/26/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Alexis E Harris-Medina Balance Due: 47.00
746404 1) 10/29/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
S06.OXOA
2)
Y08.89XA
Margaret P Smith Balance Due: 47.00
746404 10/28/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Matthew Vincent Balance Due: 47.00
746404 10/19/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Ryan G Wiseman Balance Due: 47.00
_ .Invoice# 471326.Balance Due �gZ;:QQ
Please remit payment promptly
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