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HomeMy WebLinkAbout331492 10/25/18 y ur C�q� �/ �� CITY OF CARMEL, INDIANA VENDOR: 355031 �, ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH WfOK AMOUNT: $*******166.00* r aa' CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 331492 9��TON� CHICAGO IL 60677-7001 CHECK DATE: 10/25/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340799 536736 166.00 OTHER MEDICAL FEES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 355031 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER COMMUNITY OCCUPATIONAL HEALTH SERVI IN SUM OF$ 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 536736 43-407.99 $166.00 1 hereby certify that the attached invoice(s),or 10/22/18 536736 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 Monday, October 22,2018 ,Dr �_ -:;� 4 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 October 02, 2018 Bill to: Accounts Payable For: Carmel Fire Department City of Carmel 09/18 1 Civic Square Carmel, IN 46032- Invoice# 536736 Proc Code Date Description QtV Charge Receipt Adjust Balance 80301 09/11/2018 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 09/11/2018 Breath Alcohol Test 1.00 32.00 32.00 Mark A Cromlich XXX-XX=6788 Balance.Due: 83.00 -------------_...---._--.. _.................... _.__........ _ _ . _ __ -- .... .._ .... .. _ _> .._......._.._.......- ..__._._... 80301 05/25/2018 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 05/25/2018 Breath Alcohol Test 1.00 32.00 32.00 Todd T Utzig XXX-XX-1967 Balance Due: 83.00 Invoice# 536736 Balance Due: 166.00 Please remit payment promptly