HomeMy WebLinkAbout196300 04/13/2011 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CFiE& AMOUNT: $74.00
CARMEL, INDIANA 46032 P 0 BOX 19363
INDIANAPOLIS IN 46219 CHECK NUMBER: 196300
CHECK DATE: 4/13/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347000 290310 74.00 WORKMEN'S COMPENSATIO
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
Phone: 317- 355 -6335
FEIN: 35- 1955223
Invoice
April 04, 2011
Bill to: Jim Spelbring For: Carmel Utilities
Cannel Utilities 3/11
1 Civic Square
Cannel, IN 46032-
Invoice 290310
Proc Code Date Description Qty_ Charge Receipt Adjust Balance
03/30/2011 Whisper "rest 1.00 7.00 7.00
81002 03/30/2011 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00
99173 03/30/2011 Suellen 1.00 7.00 7.00
99386 03/30/2011 DOT /PPCL Exam 1.00 5100 53.00
Dennis M Russ XXX -XX -4592 Balance Due: 74.00
Invoice 290310 Balance Due: 74.00
PLEASE REMIT PAYMENT PROMPTLY
D Q
f APR 11 2011
By
c� Cut and return with payment
VOUCHER NO. WARRANT NO.
ALLOWED 20
Community Occupational Health Services
IN SUM OF
PO Box 19383
Indianapolis, IN 46219
$74.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# Dept. INVOICE NO. I ACCT #/TITLE AMOUNT Board Members
1205 I 290310 I 43- 470.00 I $74.00 1 hereby certify that the attached invoice(s), or
1 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, Apri ,11, 2011
Director, Ad nistration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/04/11 290310 $74.00
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
20
Clerk- Treasurer