HomeMy WebLinkAbout321862 02/13/18 CITY OF CARMEL, INDIANA VENDOR: 367222
ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $.....**127.00*
;. ?Q CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 321862
CHICAGO IL 60686-0020 CHECK DATE: 02/13/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER _ AMOUNT DESCRIPTION
1201 4358800 761284 127.00 TESTING FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ CITY OF CARMEL
2046 RELIABLE PKWY 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 60686-0020
Payee
$127.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
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
761284 43-588.00 $127.00 1 hereby certify that the attached invoice(s),or 1/31/18 761284 Jan Onsite Occupational UDS $127.00
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
Thursday, February 08,2018
Lamb, Barbara
Director
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
,20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
SIM Indiana University Health Workplace Services,LLC
714 N.Senate Avenue
Suite 200
Indianapolis, IN 46202
317-963-1535
Tax ID# 20-0994452
Invoice
January 31, 2018
Bill to: Barbara Lamb For: City of Cannel-Onsite
City of Carmel-Onsite Occupational UDS/Jan.2018
1 Civic Square
Carmel,IN 46032-
Invoice# 761284
Service Date DescriptionQuant! Charge Receip Ad'us Balance
12/04/2017 Regulated Drug Screen
15.00
Invoice# 761284(continued)page 2
Service Date Description Quanti Charge Recelp Adjust Balance
127.00
UPDATED INVOICE-PLEASE MAKE PAYMENT TO THE ADDRESS LISTED BELOW WITHIN 30 DAYS OF
INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK
FEB 0 7 2018