HomeMy WebLinkAbout214990 12/04/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
` ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH gER�[
CARMEL, INDIANA 46032 7169 SOLUTION CENTER S� CK AMOUNT: $45.00
`+ CHICAGO IL 60677-7001
CHECK NUMBER: 214990
CHECK DATE: 12/4/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 334768 45 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001 R .rf,a=-- — -
Phone: 317-621-0337
FEIN: 35-1955223 NOV 0 7 2012
Invoice
November 02, 2012
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks & Recreation 10/12
1411 E. 116th St.
Cannel, IN 46032-
Invoice # 334768
Proc Code Date Description Qty Charge Recei t Adjust Balance
746404 10/23/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Kirsten Q Holston Balance Due: 45.00
Invoice# 334768 Balance Due: 45.00
WE WISH TO INFORM YOU THERE WILL BE A SLIGHT RATE INCREASE
EFFECTIVE 11/01/2012. THANK YOU
Purchase
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Approval Date
Cut and return with payment
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
355031 Community Occupational Health Services Terms
7169 Solution Center
Chicago, IL 60677-7001
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
11/2/12 334768 Pre-employment drug testing $ 45.00
Total $ 45.00
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
20_
Clerk-Treasurer
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 45.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-99 334768 4340700 $ 45.00 1 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
29-Nov 2012
I
Signature
$ 45.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I