HomeMy WebLinkAbout326720 06/29/18 0%'��p'.' CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH NfOK AMOUNT: $********83.00*
s.. ?� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 326720
9M,��oN�` CHICAGO IL 60677-7001 CHECK DATE: 06/29/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340799 526029 83.00 OTHER MEDICAL FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 355031 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
COMMUNITY OCCUPATIONAL HEALTH SERVI IN SUM OF$ 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
526029 43-407.99 .$83.00 1 hereby certify that the attached invoice(s),or 6/19/18 526029 $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
Wednesday,June 20,2018
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
, 20
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
June 04, 2018
Bill to: Accounts Payable For: Carmel Fire Department
City of Carmel 05/18
1 Civic Square
Carmel, IN 46032-
Invoice# 526029
Proc Code Date Description Q—t r Charge Receipt Adiust Balance
80301 05/19/2018 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 05/19/2018 Breath Alcohol Test 1.00 32.00 32.00
Kent C Steury XXX-XX-9435 Balance Due: 83.00
Invoice# 526029 Balance Due: 83.00
Please remit payment promptly