HomeMy WebLinkAbout308508 02/28/17 CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH Q199K AMOUNT: $********83.00*
r. is CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 308508
9Mirori�°� CHICAGO IL 60677-7001 CHECK DATE: 02/28/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 490988 83.00 TESTING FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 355031 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
COMMUNITY OCCUPATIONAL HEALTH SERVI IN SUM of$ CITY OF CARMEL
7169 SOLUTION CENTER An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
CHICAGO, IL 60677-7001
Payee
$83.00
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
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
480988 43-588.00 $83.00 1 hereby certify that the attached invoice(s),or 2/2/17 480988 $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
Tuesday, February 14,2017
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
February 02, 2017
Bill to: Jim Spelbring For: Carmel Police Department
Carmel Police Department 1/17
1 Civic Square
Carmel, IN 46032-
Invoice# 480988
Proc Code Date Description Qty Charge Receipt Adiust Balance
80301 01/24/2017 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 01/24/2017 Breath Alcohol Test 1.00 32.00 32.00
Richard E Thomas XXX-XX-2662 Balance Due: 83.00
Invoice# 480988 Balance Due: 83.00
Please remit payment promptly
Submitted To
FEB 13 2017
Clerk Treasurer
p� Cut and return with payment
p— ----------------- ------------------------------------------------------------
Please remit 83.00 to Community Occupational Health Services
7169 Solution Center
Please place invoice number 480988 on check Chicago,IL 60677-7001
Phone: 317-621-0341