HomeMy WebLinkAbout334027 01/04/19 ! CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH�jff AMOUNT: $********57.00*
�' ?Q CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 334027
9M�(iON��.� CHICAGO IL 60677-7001 CHECK DATE: 01/04/19
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 544944 57.00 TESTING FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 355031
COMMUNITY OCCUPATIONAL HEALTH SERVI IN SUM OF$ 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
$57.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Human Resources 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
544944 43-588.00 $57.00 1 hereby certify that the attached invoice(s),or 12/17/18 544944 Testing $57.00
1201 101 Prior Year 1201 101
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday,January 3,2019
O
Lamb, Barbara
Director
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001 sb$
Phone: 317-621-0341 2
FEIN: 35-1955223
Invoice
December 17, 2018
Bill to: Jim Spelbring For: Carmel Mayor's Office
Carmel Mayor's Office 12/18
1 Civic Square
Carmel, IN .46032-
Invoice# 544944
Proc Code Date Description - Charge Receipt Adjust Balance
82075 12/15/2018 Breath Alcohol Test 1.00 32.00 32.00
99000 12/15/2018 Drug Screen-Collection Only 1.00 25.00 25.00
2049017172
James Brainard XXX-XX-7668 Balance Due: 57.00
Invoice# 544944 a an eDue: 7 00
Please remit payment promptly
Submitted To
JAN 0 3 2019
Clerk Treasurer