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