HomeMy WebLinkAbout322439 03/05/18 D 1yCITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%k!RQK AMOUNT: S"".""94.00`
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 322439
CHICAGO IC 60677-7001 CHECK DATE: 03/05/18
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 517219 94.00 MEDICAL FEES
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
VOUCHER NO. WARRANT NO.
An invoice of bill to be properly itemized must show,kind of service,where performed,dates service rendered,by
Vendor# 355031 Allowed 20_ whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
Community Occupational Health Services Payee
7169 Solution Center
Chicago, IL 60677-7001 In Sum of$ Purchase Order#
355031 Community Occupational Health Services Terms
$ 94.00 7169 Solution Center Date Due
Chicago, IL 66677-7001
ON ACCOUNT OF APPROPRIATION FOR
108-ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Invoice Description
Dept# Invoice Date Number (or note attached invoice(s)or bill(s)) PO# Amount
1081-99 517219 4340700 $ 94.00 Board Members 2/15/18 517219 Pre-Employment Drug Testing xx6509 $ 94.00
I hereby certify that the attached invoice(s),or
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
$ 94.00 Total $ 94.00
February 26,2018
1 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
Cost distribution ledger classification if
claim paid motor vehicle highway fund Signature 20_
Accounts Payable Coordinator Clerk-Treasurer
Title
Gobi urnurn rnty p fional=Healtf ;Svs
716.9 Solution Center
�° E s'T F� Chicago;1L}60677 7001 *=
Phone: 317-621-0341
FEB 2 2 203 FEIN: 35-1955223
Invoice
�February_-1F5;_2018;,
Bill to: Lynn Russell For: Carmel Clay Parks &Recreation
Carmel Clay Parks &Recreation 02/18
1411 E. 116th St.
Carmel, IN 46032-
Inv0x0e#517219
Proc Code Date Description Q_yt Charge Receipt Adjust Balance
746404 02/13/2018 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Donamarie V Kelley Balance Due: 47.00
746404 02/14/2018 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Robert Wittig Balance Due: 47.00
Invoice# 517219
_
Please remit payment promptly