HomeMy WebLinkAbout319365 12/05/2017 CITY OF CARMEL, INDIANA VENDOR: 355031
"j ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH G19RQK AMOUNT: $********83.00*
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 319365
.9 �TON. CHICAGO IL 60677-7001 CHECK DATE: 12/05/17
DEPARTMENT ACCOUNT PO NUMBER _ INVOICE NUMBER AMOUNT_ DESCRIPTION
1120 4340799 508290 83.00 OTHER MEDICAL FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts city Form No.201 (Rev.1995)
Vendor# 355031
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IN SUM OF$ CITY OF CARMEL
COMMUNITY OCCUPATIONAL HEALTH SERVI
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
Carmel Fire 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
508290 43-407.99 $83.00 1 hereby certify that the attached invoice(s),or 12/1/17 508290 $83.00
1120 101 1120 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
Friday, December 01,2017
David Haboush
Fire Chief
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
120
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
November 21, 2017
Bill to: Accounts Payable For: Carmel Fire Department
City of Carmel 11/17
1 Civic Square
Carmel, IN 46032-
Invoice# 508290
Proc Code Date Description Qty Charge Receipt Adjust Balance
80301 11/06/2017 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 11/06/2017 Breath Alcohol Test 1.00 32.00 32.00
Scott Tierney XXX-XX-1046 Balance Due: 83.00
Invoice# 508290 Balance Due: 83.00
Please remit payment promptly