HomeMy WebLinkAbout331014 10/09/18 (9- )
CITY OF CARMEL, INDIANA VENDOR: 367222 '
IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: S*******761.00*
ONE CIVIC SQUARECARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 331014
CHICAGO IL 60686-0020 CHECK DATE: 10/09/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 764058 761.00 TESTING FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ CITY OF CARMEL
2046 RELIABLE PKWY 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 60686-0020
Payee
$761.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Human Resources 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
764058 43-588.00 $761.00 1 hereby certify that the attached invoice(s),or 9/30/18 764058 Onsite Occ UDS Sept 2018 $761.00
1201 101 1201 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
Tuesday, October 2,2018
Lamb, Barbara
Director
I 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
sem, Indiana University Health Workplace Services,LLC
714 N.Senate Avenue
Suite 200
Indianapolis, IN 46202
317-963-1535
Tax ID# 20-0994452
Invoice
September 30, 2018
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Occupational UDS/Sept.'18
1 Civic Square
Carmel,IN 46032-
Invoice# 764058
Service Date Description Quanti Charae Recelp Ad•us Balance
09/20/2018 Quick Read UDS/6panel includes
15.00
kit
S, au ped To
"1 01 2018
Invoice# 764058(continued)page 2
Service Date Description
15.00
09/13/2018 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
Jeremy Johnson XXX-XX-1762 Balance Due: 15.00
Invoice# 764058(continued)page 3
Service Date Description Quanti Charce Recelp Ad"Us Balance
09/25/2018 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
09/25/2018 Confirmation for Quick Read Drug 1.00 15.00 15.00
Screen
15.00
Invoice# 764058(continued)page 4
Service Date Description Quantity Charge Receip Adjust Balance
09/11/2018 Quick Read UDS/6panel
22.00
Invoice# 764058(continued)page 5
Service Date Description Quantity Charge Re i Ad'us Balance
09/27/2018 Quick Read UDS/6panel includes 1.00 15.00 15.00
kit
761.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK