HomeMy WebLinkAbout326056 06/12/18 9, 4�p\ CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH eMfVK AMOUNT: $********83.00*
CHICAGO CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 326056
M,Is6i moo. CHICAGO IL 60677-7001 CHECK DATE: 06/12/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340799 524585 83.00 OTHER MEDICAL FEES
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 355031
COMMUNITY OCCUPATIONAL HEALTH SERVI IN SUM of$ 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
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
524585 43-407.99 $83.00 1 hereby certify that the attached invoice(s),or 6/4/18 524585 $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
Tuesday, June 05,2018
U.®r
David Haboush
Fire Chief
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
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
May 15, 2018
Bill to: Accounts Payable For: Carmel Fire Department
City of Carmel 05/18
1 Civic Square
Carmel, IN 46032-
Invoice # 524585
Proc Code Date Description Qtv Chane Receipt Adjust Balance
80301 05/04/2018 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 05/04/2018 Breath Alcohol Test 1.00 32.00 32.00
John F Moriarty XXX-XX-6680 Balance Due: 83.00
Invoice# 524585 Balance Due: 83.00
Please remit payment promptly
Cut and return with payment
Please remit 83.00 to . Community Occupational Health Services
7169 Solution Center
Please place invoice number 524585 on check Chicago,IL 60677-7001
Phone: 317-621-0341