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