HomeMy WebLinkAbout209967 06/20/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH gER�[
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK AMOUNT: $74.00
CHICAGO IL 60677 -7001
CHECK NUMBER: 209967
CHECK DATE: 6120/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 294440 74.00 EMPLOYEE PENSIONS B
Community Occupational Health Services
7189 Solution Center
Chicago, IL 80677'7001
Phone: 317'621'0337
FEIN: 35'1855223
Invoice
jUOe 02.2011
Bill ho: ]irn 3po|bhng Poi Curmn| [Jb|idra
Carmel Utilities 5/11
Civic 3qumn
Carmel, IN 46032-
lovoicc# 294440
Ploc Code Date Description oty Charge Receipt Balance
05/23/2011 Whisper Test 1.00 7D0 7D0
81002 05/23/2011 Urinalysis, Mini Dip v/Physical 1.00 7.00 7.00
99173 05/232011 SnnUcn 1.00 780 7.00
99380 05/23/2011 D0T/PPCLCxum 100 53.00 53.00
Robbie LKinkead ��3�Q l B
n u uouco Due: 74.00
loroirc# 294440 Balance Due: 74.00
PLEASE REMIT PAYMENT PROMPTLY
cmaiidmm With panrlel`t
cr
Please /cmi|74.O0m Cummunity Occupational Health Services
7]0g8o|uhooCenter
Please place invoice oumbnr294440oncheck Chicuao.LL 60677'7001
Phone: 317 -0337
I IN
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 6/5/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/5/2012 294440 $74.00
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
Date Officer
VOUCHER 125070 WARRANT ALLOWED
355031 IN SUM OF
COMMUNITY OCCUPATIONAL HEALTI
7710 Sdfi fha,(l C14
C /-7, c- 06"7`7
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
294440 01- 7042 -06 $74.00
Voucher Total $74.00
Cost distribution ledger classification if
claim paid under vehicle highway fund