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Home My WebLink About235074 7 /22/2014 0 ��`'' CITY OF CARMEL, INDIANA VENDOR: 355031 �1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%IdrtVK AMOUNT: $*****""314.00" ;. � CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 235074 v�, CHICAGO IL 60677-7001 CHECK DATE: 07/22/14 «UN� DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 388254 47.00 MEDICAL FEES 1082 4340700 388254 188.00 MEDICAL FEES 651 5023990 389203 79.00 OTHER EXPENSES Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 b Phone: 317-621-0341 FEIN: 35-1955223 v JUL - 7 2014 Invoice July 02, 2014 Bill to: Lynn Russell For: Carmel Clay Parks &Recreation Carmel Clay Parks &Recreation 6/14 1411 E. 116th St. Carmel, IN 46032- Invoice# 388254 Proc Code Date Description QQt rr Charge Receipt Adjust Balance 746404 06/17/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Katrina E Bell Balance Due: °� 47.00 746404 06/26/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Adria nna L Carlisle Balance Due: °t✓ 47.00 746404 06/26/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Kiera McConnell Balance Due: S 47.00 746404 06/15/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Alex J Mueller Balance Due: 47.00 746404 06/25/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Karen Pajot Balance Due: 47.00 Invoice# 388254 Balance Due: ✓ 235.00 PLEASE REMIT PAYMENT PROMPTLY Purchase , A ��' 2S Gs-cription f1/I�- . (I�1)- UT.QS�n P.O.# — PorF J a.L.� t sud,et r \ Line Descr hA Q PurchaserQ Approval Date 0 I o 8' l-49 — L130 v0 toga- 4R - y3 �L0'7D0 = X79.00 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 7/2/14 388254 Pre-employment drug testing $ 47.00 7/2/14 388254 Pre-employment drug testing $ 188.00 Total Is 235.00 1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in acdordance with IC 5-11-10-1.6 120 Clerk-Treasurer i Voucher No. Warrant No. 355031 Community Occupational Health Services Allowed 20 7169 Solution Center Chicago, IL 60677-7001 In Sum of$ $ 235.00 f ON ACCOUNT OF APPROPRIATION FOR 108 ESE i PO#orBoard Members Dept# INVOICE NO. CCT#/TITL AMOUNT , 1081-99 388254 4340700 $ 47.00 1 hereby certify that the attached invoice(s), or 1082-99 388254 4340700 $ 188.00 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 1 16-Jul 2014 $ 235.00 i Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund I Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice July 02, 2014 Bill to: Jim Spelbring For: Carmel Utilities Carmel Utilities 6/14 1 Civic Square Carmel, IN 46032- Invoice# 389203 Proc Code Date Description Qty Charge Recei t Adjust Balance 06/20/2014 Whisper Test 1.00 8.00 8.00 81002 06/20/2014 Urinalysis,Mini Dip w/Physical 1.00 8.00 8.00 99173 06/20/2014 Snellen 1.00 8.00 8.00 99386 06/20/2014 DOT/PPCL Exam 1.00 55.00 55.00 Michael B Turner XXX-XX-1578 Balance Due: 79.00 Invoice# 389203 Balance Due: 79.00 PLEASE REMIT PAYMENT PROMPTLY Cut and return with payment `=----------------------------------------------------------------------------------------------- - Please remit 79.00_to _ Community Occupational Health Services - 7169 Solution Center Please place invoice number 389203 on check Chicago,IL 60677-7001 Phone: 317-621-0341 VOUCHER # 145097 WARRANT# ALLOWED 355031 IN SUM OF $ i COMMUNITY OCCUPATIONAL HEALTI 7169 Solution Center Chicago, IL 60677-7001 I Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code i 389203 01-7752-05 $79.00 Voucher Total $79.00 Cost distribution ledger classification if claim paid under vehicle highway fund Pt4 �7i$ry Prescribed by State Board of Accounts City Form No.201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL I� 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. 7169 Solution Center Terms Chicago, IL 60677-7001 Due Date 7/16/2014 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 7/16/2014 389203 $79.00 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 -7 Date Officer