HomeMy WebLinkAbout325130 05/09/18 ���.�,q" CITY OF CARMEL, INDIANA VENDOR: 355031
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•; ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH�ROK AMOUNT: $********51.00*
r. ?�; CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 325130
9��ON,�� CHICAGO IL 60677.7001 CHECK DATE: 05/09/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 521914 51.00 MEDICAL EXAM FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 355031 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
COMMUNITY OCCUPATIONAL HEALTH SERVI IN SUM OF$ 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
$51.00
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police 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
521914 43-407.01 $51.00 1 hereby certify that the attached invoice(s),or 4/16/18 521914 blood draw-White $51.00
1110 101 1110 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
Monday, May 7,2018
$c'..' v6.Aw
Jim Barlow
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
,20—
Cost
20Cost 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
April 16, 2018
Bill to: Jim Spelbring For: Carmel Police Department
Carmel Police Department 4/18
1 Civic Square
Carmel, IN 46032-
Invoice# 521914
Proc Code ICD Date Description QtV Charge Receipt Adiust Balance
80301 1) 04/03/2018 Rapid 5 Panel UDS 1.00 51.00 51.00
S43.402A
2)
S80.212A
Robert E White II XXX-XX-4397 Balance Due: 51.00
K— Invoice# 521914 Balance Due: 51.00
Please remit payment promptly