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