HomeMy WebLinkAbout332311 11/13/18 CITY OF CARMEL, INDIANA VENDOR: 367222
® ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $.....**112.00*
CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 332311
CHICAGO IL 60686-0020 CHECK DATE: 11/13/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 764180 112.00 TESTING FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ 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
$112.00
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
764180 43-588.00 $112.00 1 hereby certify that the attached invoice(s),or 10/31/18 764180 Oct 2018 Occ UDS $112.00
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
Monday, November 5,2018
LAs.--d c�"Q
Crider,James
Administration
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
Indiana University Health Workplace Services, LLC
714 N.Senate Avenue
Suite 200
Indianapolis, IN 46202
317-963-1535
Tax ID# 20-0994452
Invoice
October 31, 2018
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Occupational UDS/Oct.2018
1 Civic Square
Carmel,IN 46032-
Invoice# 764180
Service Date Description Quantity Charge Recelp Aftsi Balance
10/01/2018 Quick Read UDS/6panel
15.00
kit
NOV 2018
Invoice# 764180(continued)page 2
Service Date DescriptionQuant! Charge Recei Adjust Balance
15.00
CITYCARO Invoice# 764180 Balance Due: 112.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK