HomeMy WebLinkAbout172789 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $74.00
CAR 4ZL, INDIANA 46032 P 0 BOX 19383
INDIANAPOLIS IN 46219
CHECK NUMBER: 172789
CHECK DATE: 5/27/2009
DEPA A CCOUNT PO NUMB INVO ICE NUM A MOUN T DESCR
651 5023990 239057 74.00 OTHER EXPENSES
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Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
317- 355 -6335
Tax ID 35- 1955223
Invoice
May 05, 2009
B,i11 to: Shelly Lingelbaugh For: Carmel Utilities
Cannel Utilities 4/09
1 Civic Square
Carmel, IN 46032-
Invoice 239057
oc Code Service Date Description Quantity Charge Recei t Adiust Balance
04/21/2009 Whisper Test 1.00 7.00 7.00
,1!002 04/21/2009 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00
9'%173 04/21/2009 Suellen 1.00 7.00 7.00
04/21/2009 DOT /PPCL Exam 1.00 53.00 53.00
r; Dennis M Russ Sr. XXX -XX -4592 Balance Due: 74.00
Invoice 239057 Balance Due: 74.00
PLEASE REMIT PAYMENT PROMPTLY. THANK YOU
Cut and return with payment
Please remit 74.00 to Connnunity Occupational Health Services
P.O. Box
Please place invoice number 239057 on check I
Indianapolislis, IN 46219
Phone: 317 355 -6335
1
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
355031
COMMUNITY OCCUPATIONAL HEALTH Purchase Order No.
PO BOX 19383 Terms
INDIANAPOLIS, IN 46219 Due Date 5/18/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/18/2009 239057 $74.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
Drrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer
.i
VOUCHER 095641 WARRANT ALLOWED
355031 IN SUM OF
G OCCUPATIONAL HEALTI
PO BOX 19383
?INDIANAPOLIS, IN 46219
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
239057 01- 7042 -06 $74.00
U
Voucher Total $74.00
Cost distribution ledger classification if
claim paid under vehicle highway fund