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HomeMy WebLinkAbout328825 08/14/18 CITY OF CARMEL, INDIANA VENDOR: 355031 I; ® ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%Uf4K AMOUNT: $*******141.00* 9, ?� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 328825 CHICAGO IL 60677-7001 CHECK DATE: 08/14/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 529987 141.00 MEDICAL FEES ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL VOUCHER NO. WARRANT NO. An invoice of bill to be properly itemized must show;kind of service,where performed,dates service rendered,by Vendor# 355031 Allowed 20 whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. Community Occupational Health Services Payee 7169 Solution Center Chicago, IL 60677-7001 In Sum of$ Purchase Order# 355031 Community Occupational Health Services Terms $ 141.00 7169 Solution Center Date Due Chicago, IL 60677-7001 ON ACCOUNT OF APPROPRIATION FOR 108-ESE Fund PO#ornvolce Description Dept# INVOICE NO. ACCT#/TITLE AMOUNT Invoice Date Number (or note attached invoice(s)or bill(s)) PO# Amount 1081-99 529987 4340700 $ 141.00 Board Members 7/16/18 529987 Pre-Employment Drug Testing xx7293 $ 141.00 1 hereby certify that the attached invoice(s),or 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 $ 141.00 Total $ 141.00 August 8,2018 1 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 Cost distribution ledger classification if claim paid motor vehicle highway fund Signature 20_ Accounts Payable Coordinator Clerk-Treasurer Title f Co i Occupatro,b Health Svs 7;�1`69SoCutlon yCenter� Chicago-IL" 6067�7'7®01 J U L � 9 ��18 Phone FEIN: 35-1955223 Invorce.f, July Bill to: Lynn Russell For: Carmel Clay Parks &Recreation Carmel Clay Parks &Recreation 07/18 1411 E. 116th St. Carmel, IN 46032- voice ;:' Proc Code ICD Date Description Qty Charge Recei t Adiust Balance 746404 1) 07/03/2018 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Y04.1XXA Thomas L Brown Balance Due: 47.00 ------- --------------------------------------------------------------- - ------------------ 746404 07/06/2018 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Cameron E Johnson Balance Due: 47.00 _........... .. ............ ._...-............ ................__... ._............__.................. _. 746404 1) 07/11/2018 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 S 83.92XA 2) W01.198A Katie D Sites Balance Due: 47.00 I woice�##�529987Balance'I7ue �-���141=;0O, :w 4w Please remit payment promptly L�a