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HomeMy WebLinkAbout333777 12/21/18 �o�e�xb J`! w� CITY OF CARMEL, INDIANA VENDOR: 355031 I; .�Q ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH�ft9K AMOUNT: $*******141.00* =v� jr, CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 333777 MR'r'oi+"�O' CHICAGO IL 60677-7001 CHECK DATE: 12/21/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 543265 141.00 MEDICAL FEES ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL VOUCHER NO. WARRANT NO. An invoice of bill to be properly itemized must show;kind of service,where performed,dates service rendered,by Vendor# 355031 Allowed 20_ whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. Community Occupational Health Services Payee 7169 Solution Center Chicago, IL 60677-7001 In Sum of$ Purchase Order# 355031 Community Occupational Health Services Terms $ 141.00 7169 Solution Center Date Due Chicago, IL 60677-7001 ON ACCOUNT OF APPROPRIATION FOR 108-ESE Fund PO#or --- Invoice Description Dept# INVOICE No. ACCT#/TITLE AMOUNT Invoice Date Number (or note attached invoice(s)or bill(s)) PO# Amount 1081-99 543265 4340700 $ 141.00 Board Members 12/4/18 543265 Pre-Employment Drug Testing xx7765 $ 141.00 I hereby certify that the attached invoice(s),or 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 $ 141.00 Total $ 141.00 December 20,2018 1 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 Cost distribution ledger classification if claim paid motor vehicle highway fund Signature 20_ Accounts Payable Coordinator Clerk-Treasurer Title R - Community®ccupat1onai HeaRh Susi . Solut' n Center ` 7169 0 Chicago IL 60677-7001 317 621-0 7 .�---Phone - l. .. . ,T e: � FEIN, - .35:1955223 _ DEG .J: Invoice: .. . . . ®ecember 04,.2018 Bill to: . Camille Nelsen : . :: For: :: Carmel Clay Parks:&Recreation. : .Carmel:Clay:Parks&,Recreation. 1411 E: 1-16th St Carmel;IN 46032= ice#` 543265 :Roc Code Date :; . Doscriofion (.. Charge : Rocelot -Adjust '. .Balance 746404 11/29/2018: . Drug Screen-Non NIDA:5 Panel i.00: . 47.00 . • .Karl 'en Griffin Balance Due: : 47.00.- 746:404 11/27/20I8 Drug Screen-Non.NIDA:S Panel 1:.00 42:00 '47.00 •Madison E Helding Balance Due: 47.00` 746.464 11!28/201.8 ::Drua Screen-.Non NIDA.5.Panei. LOO: . 47.00 47.00 Brandon Marshall Balance Due: Invoice#.543265 Balance Due: 14=1T 00 Please remit payment_promptly