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HomeMy WebLinkAbout330578 10/02/18 J`('��p''• CITY OF CARMEL, INDIANA VENDOR: 355031 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH�fOK AMOUNT: $*******166.00* %. �� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 330578 94j��ioeTE°'�9 CHICAGO IL 60677-7001 CHECK DATE: 10/02/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION' 1120 4340799 535810 166.00 OTHER MEDICAL FEES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 355031 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER COMMUNITY OCCUPATIONAL HEALTH SERVI IN SUM OF$ 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 535810 43-407.99 $166.00 1 hereby certify that the attached invoice(s),or 9/24/18 535810 Post Accident Testing $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 Thursday, September 27,2018 pe.�D - 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 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 September 17, 2018 Bill to: Accounts Payable For: Carmel Fire Department City of Carmel 09/18 1 Civic Square Carmel, IN 46032- Invoice# 535810 Proc Code Date Description QtV Charge Receipt Adiust Balance 80301 09/06/2018 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 09/06/2018 Breath Alcohol Test 1.00 32.00 32.00 Brian E Smith XXX-XX-3766 Balance Due: 83.00 _....__._...._... - - .. -----_.._._.._....__.._._...... __....................._...... 80301 09/06/2018 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 09/06/2018 Breath Alcohol Test 1.00 32.00 32.00 Gregory A Webb XXX-XX-0349 Balance Due: 83.00 Invoice# 535810 Balance Due: 166.00 Please remit payment promptly r.......a tee.....,...:.t,.,.,...,,o...