HomeMy WebLinkAbout228484 1 /28/2014 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
„*f ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH URK AMOUNT: $78.00
CARMEL, INDIANA 46032 7169 SOLUTION CENTER
o� CHICAGO IL 60677-7001 CHECK NUMBER: 228484
CHECK DATE: 1/28/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4340700 371002 78 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
RJEC
JAN 13 2014
Invoice _...__.�._---
January 03, 2014
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks & Recreation 12/13
1411 E. 116th St.
Carmel, IN 46032-
Invoice# 371002
Proc Code Date Description Qty Charge Receipt Adjust Balance
746404 12/16/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
82075 12/16/2013 Breath Alcohol Test 1.00 31.00 31.00
Shawn Hart Balance Due: 78.00
Invoice# 371002 Balance Due: 78.00
PLEASE REMIT PAYMENT PROMPTLY
Purchase
Description
P.O.# PorF
G.L.# d� U "000— `13q0700 \
Budget Q
Line escr ?
Purchase e ( 3 y
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
1/3/14 371002 Pre-employment drug testing $ 78.00
Total $ 78.00
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with I C 5-11-10-1.6
20_
Clerk-Treasurer
I
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 78.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
Po#or Board Members
INVOICE NO. CCT#/TITL AMOUNT
Dept#
1125 371002 4340700 $ 78.00 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
21-Jan 2014
$ 78.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
it