HomeMy WebLinkAbout333470 12/14/18 W_c�N
CITY OF CARMEL, INDIANA VENDOR: 355031
(/ �;,• ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH�fOK AMOUNT: $.......166.00*
rC /?�; CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 333470
9.i;,��oN_�: CHICAGO IL 60677-7001 CHECK DATE: 12/14/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340799 543686 166.00 OTHER MEDICAL FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 355031 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
COMMUNITY OCCUPATIONAL HEALTH SERVI IN SUM OF$ 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
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
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
543686 43-407.99 $166.00 1 hereby certify that the attached invoice(s),or 12/11/18 543686 Post Accident $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
Tuesday, December 11,2018
D440 _'ZS_
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
120—
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
December 04, 2018
Bill to: Accounts Payable For: Carmel Fire Department
City of Carmel 11/18
1 Civic Square
Carmel, IN 46032-
Invoice# 543686
Proc Code Date Description Q�t Charge Recei t Adiust Balance
80301 11/30/2018 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 11/30/2018 Breath Alcohol Test 1.00 32.00 32.00
Brandon Greiner XXX-XX-0546 Balance Due: 83.00
--------....------.-------------------------.-...----- - ..-- ----------.--...........................------------....
80301 11/30/2018 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 11/30/2018 Breath Alcohol Test 1.00 32.00 32.00
Brian E Smith XXX-XX-3766 Balance Due: 83.00
Invoice# 543686 Balance Due: 166.00
Please remit payment promptly
d — Cut and return with payment
----------------------------------------------------------------------------------------------------------------
Please remit_166.00 to Community Occupational Health Services
7169 Solution Center
Please place invoice number 543686 on check Chicago,IL 60677-7001
Phone:.317-621-0341