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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 !1-� w