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Home My WebLink About235789 08/13/14 (9, CITY OF CARMEL, INDIANA VENDOR: 355031 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH$kIR9K AMOUNT: $R R R R R R R'23'7.00* CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 235789 CHICAGO IL 60677-7001 CHECK DATE: 08/13/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 390381 47.00 MEDICAL FEES 1082 4340700 390381 94.00 MEDICAL FEES 1091 4340700 390381 47.00 MEDICAL FEES 2201 4239099 392256 49.00 OTHER MISCELLANOUS Community Occupational Health Svs 71Solution 69 Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice August 01, 2014 Bill to: Jim Spelbring For: Carmel Street Dept. Carmel Street Dept. 7/14 1 Civic Square Carmel, IN 46032- . Invoice# 392256 Proc Code Date Description Qty Charge Receipt Adjust Balance 07/24/2014 Respirator Fit Test 1.00 49.00 49.00 Mark Callahan XXX-XX Jalance Due: 49.00 Invoice# 392256 Balance Due: 49.00 PLEASE REMIT PAYMENT PROMPTLY Cut and return with payment VOUCHER NO. WARRANT NO. ALLOWED 20 Community Occupational Health Services IN SUM OF$ 7169 Solution Center Chicago, IL 60677-7001 $49.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members 2201 I I 42-390.991 $49.00 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 uaycd/ i 2014-01111111o ' StFeat 0 M Street Commisssiorner Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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 service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 08/01/14 $49.00 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 Purchase C � Description Q eS Community Occupational Health Svs �-- P or 1- 7169 Solution Center P.O.# Chicago, IL 60677-7001 one: 317-621-0341 JUL 2 1 2014 Budget �Q,p C h,{ ElN: 35-1955223 Line%t I/ Purchase ate 2l 7 BY:— Purchase, Date- 9 ate Jo9� — V3 Vo 706 — K. 0() l U Sl-9 I— y3 Vo 100 — V7° 0() Invoice 108a- 9 ?- y3 Yo 700— 9yQ 00 July 18, 2014 Bill to: Lynn Russell For: Carmel Clay Parks &Recreation Carmel Clay Parks & Recreation 7/14 1411 E. 116th St. Carmel, IN 46032- Invoice# 390381 Proc Code ICD9 Date Description Qty Charge Receipt Adjust Balance 746404 07/03/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Anne Marie Bessler Balance Due: rY 47.00 746404 07/08/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 7 t - Luke A Dietz Balance Due: C' 47.00 746404 07/16/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Indu Garg Balance Due: 47.00 746404 1)845.00 07/16/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 2) E885.9 Cherrie A Palmer Balance Due: 47.00 Invoice# 390381 Balance Due: 188.00 PLEASE REMIT PAYMENT PROMPTLY o� 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 7/18/14 390381 Pie-employment drug testing $ 47.00 -6-u--71-18/1.4 ___ __89Q381 Pre-employment drug testing $ 47.00 7/18/14 390381 Pre-em loyment drug testing $ 94.00 Total $ 188.00 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. I ' 355031 Community Occupational Health Service� Allowed 20 7169 Solution Center Chicago, IL 60677-7001 In Sum of$ I $ 188.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE/109 Monon Center y PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members Dept# 1091 390381 4340700 $ 47.00 1 hereby certify that the attached invoice(s), or 1081-99 390381 4340700 $ 47.00 bill(s)is(are)true and correct and that the 1082-99 390381 4340700 $ 94.00 materials or services itemized thereon for which charge is made were ordered and received except I f7-Aug 2014 $ 188.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund I • 1 1