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Home My WebLink About233987 06/25/14 J�%'�'"''�. CITY OF CARMEL, INDIANA VENDOR: 355031 ® �• ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH�R9K AMOUNT: $*******846.00* s, %a CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 233987 9r;.,.___.�o:� CHICAGO IL 60677-7001 CHECK DATE: 06/25/14 �tON DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1082 4340700 385214 846.00 MEDICAL FEES __._....._.._......._._.__._....._...._.._..._..._......_.........._......_............._............_....._.._._..._..._.._...._...._......_._.__...._._.....__._._........._._.... __......._.__.___..._.._._..........._....._-__-------------.._.__._...__.._...__._._.......___...._.........._. ._...__._._.._......._......_.........___........ Invoice# 385214 (continued)page 2 Matthew J Olson Balance Due: 47.00 746404 05/15/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Erin M Parker Balance Due: 47.00 746404 05/15/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jennifer A Robinson Balance Due: C 47.00 746404 05/20/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Collin E Skiles Balance Due: 47.00 746404 05/16/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Catherine E Surette Balance Due: C 47.00 746404 05/15/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Eric A Wiggins Balance Due: 47.00 746404 05/15/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Nadia L Zimmerman Balance Due: C 47.00 Invoice# 385214 Balance Due: / 846.00 PLEASE REMIT PAYMENT PROMPTLY PTj JUN - 5 2014 Cut and return with payment C� Community Occupational Health Svs Purchase , J\\ 7169 Solution Center � , Description Chicago, IL 60677-7001 ArL".s�';r - r P.O.# P or F Phone: 317-621-0341 ,I r/ JUN1C��?a_ - q3 7 � 1000 FEIN: 35-1955223 �N �5 2014 C.L.# f- tDate_Budget ruA ed4Line�escr Purchaser Approval Invoice June 03, 2014 Bill to: Lynn Russell For: Carmel Clay Parks &Recreation Carmel Clay Parks &Recreation 5/14 1411 E. 116th St. Carmel, IN 46032- , Invoice# 385214 Proc Code Date Description Qty Charge Receipt Adjust Balance 746404 05/14/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 { 47.00 Katelyn M Blackthorn Balance Due: (r}; 47.00 746404 05/15/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Adam C Dietz Balance Due: C 47.00 746404 05/13/2014 Drug Screen-Non NIDA 5 Panel 1.00 47:00 /+ 47.00 - Margaret C Duxbiury Balance Due: C 47.00' 746404 05/17/2014 Drug Screen-Non NIDA 5 Panel 1.00 '47.00 47.00 Brad-Lee Finn Balance Due: 47.00 746404 05/16/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Mitchell L Greene Balance Due: 47.00 746404 05/21/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Sydney M Grubb Balance Due: L 47.00 746404 05/23/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Stephanie M Lukas Balance Due: 47.00 746404 05/21/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Abigail E Martin Balance Due: 47.00 746404 05/16/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Mary C McCaulay Balance Due: 47:00 746404 05/20/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00' 47.00 Matthew L Meisenhelder Balance Due: 47.00 746404 05/20/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Richard urray BalanceDue: n 47.00 746404 05/22/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 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 6/3/14 385214 Pre-employment drug testing $ 846.00 Total $ 846.00 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 i Voucher No. Warrant No. 355031 Community Occupational Health Services i Allowed 20 7169 Solution Center Chicago, IL 60677-7001 In Sum of$ $ 846.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE 1 PO#or Board Members Dept# INVOICE NO. 4,CCT#/TITLE AMOUNT ` 1082-99 385214 4340700 $ 846.00 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 19-Jun 2014 I $ 846.00 5 Accounts Payable Coordinator Cost distribution ledger classification if I Title claim paid motor vehicle highway fund