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
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Please remit payment promptly L�a