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HomeMy WebLinkAbout333048 12/11/18 CITY OF CARMEL, INDIANA VENDOR: 355031 V� ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH tMfOK AMOUNT: $.......166.00* CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 333048 'NITON�` CHICAGO IL 60677.7001 CHECK DATE: 12/11/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340799 542394 166.00 OTHER MEDICAL FEES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 355031 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER COMMUNITY OCCUPATIONAL HEALTH SERVI IN SUM OF$ 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 542394 43-407.99 $166.00 1 hereby certify that the attached invoice(s),or 11/28/18 542394 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, December 3,2018 David Haboush Fire Chief 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 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 November 15, 2018 Bill to: Accounts Payable For: Carmel Fire Department City of Carmel 11/18 1 Civic Square Carmel, IN 46032- Invoice# 542394 Proc Code Date Description Qty Charge Receipt Adjust Balance r 80301 11/14/2018 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 11/14/2018 Breath Alcohol Test 1.00 32.00 32.00 Justin R Malicoat XXX-XX-1948 Balance Due: 83.00 --------------- - ._-.....-..._....----- _. 80301 11/14/2018 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 11/14/2018 Breath Alcohol Test 1.00 32.00 32.00 Scott A Stroup XXX-XX-8004 Balance Due: 83.00 Invoice# 542394 Balance Due: 166.00 Please remit payment promptly or— Cut and return with payment ----------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------=- Please remit 166.00 to Community Occupational Health Services 7169 Solution Center Please place invoice number 542394 on check Chicago,IL 60677-7001 Phone: 317-621-0341