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HomeMy WebLinkAbout328755 08/14/18 'o�.�qA+, CITY OF CARMEL, INDIANA VENDOR: 355031 e '� ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH�fOK AMOUNT: $.......166.00* a9� i+': CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 328755 a,��uri�. CHICAGO IL 60677-7001 CHECK DATE: 08/14/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340799 531133 166.00 OTHER MEDICAL FEES VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts city Form No.201(Rev.1995) Vendor# 355031 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER COMMUNITY OCCUPATIONAL HEALTH SERVI IN SUM OF$ 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 $166.00 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 531133 43-407.99 $166.00 1 hereby certify that the attached invoice(s),or 8/13/18 531133 $166.00 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 Monday,August 13,2018 V4MDr _ � � 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 , 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 August 02, 2018 Bill to: Accounts Payable For: Carmel Fire Department City of Carmel 07/18 1 Civic Square Carmel, IN 46032- Invoice# 531133 Proc Code Date Description Q_yt Charge Recei t Adiust Balance 80301 07/18/2018 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 07/18/2018 Breath Alcohol Test 1.00 32.00 32.00 Michael J Phillips XXX-XX-3028 Balance Due: 83.00 80301 07/12/2018 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 07/12/2018 Breath Alcohol Test 1.00 32.00 32.00 Kent C Steury XXX-XX-9435 Balance Due: 83.00 Invoice# 531133 Balance Due: 166.00 Please remit payment promptly