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