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HomeMy WebLinkAbout237355 9 /23/2014 °� �,A,f. CITY OF CARMEL, INDIANA VENDOR: 355031 4;� ® i. ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH efdAOK AMOUNT: $*******501.00* i` CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 237355 +'''�soH�� CHICAGO IL 60677-7001 CHECK DATE: 09/23/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4340700 394919 376.00 MEDICAL FEES 1125 4340700 394919 125.00 MEDICAL FEES Community Occupational Health Svs urchase J f, / raj 7-cs45) 7169 Solution Center ition ��dt`�1� l��S t /Chicago, IL 60677-7001 C).# P or F Phone: 317-621-0341 FEIN: 35-1955223 J'D 1_.# -pt SEP - 5 114 2r BY: .gal Invoice y.3 y0700 Do- o00 - y3 yo7 0 0September 03, 2014 V 3ya7oO- 0376,000`� y7 vo Bill to: Lynn Russell For: Cannel Clay Parks & Recreation Cannel Clay Parks & Recreation 8/14 1411 E. 116th St. Cannel, IN 46032- . . .. ... .. _ . ... . ........_._._.._..._._... .. ... ......-- .... . .. Invoice # 394919 __.-_...._...._..__. ...._._.__._._........................... ................._.._._._._.._-.._ Proc Code ICD9 Date Description Qty Charge Receipt Adiust Balance 746404 08/20/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Alexis S Ardaiolo Balance Due: 47.00 746404 08/28/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Mark D Aughinbaugh Balance Due: 47.00 746404 08/21/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 82075 08/21/2014 Breath Alcohol Test 1.00 31.00 31.00 William J Bass Balance Due: 78.00 746404 08/25/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 David *VV Connors Balance Due: 47.00 746404 08/28/2014 Drug Screen- Non NIDA 5 Panel 1.00 47.00 47.00 Michael J Norris Balance Due: 47.00 746404 08/28/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Catharine J Parker Balance Due: S 47.00 746404 08/21/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Divya Pathak Balance Due: 47.00 746404 1)354.0 08/25/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 2)E927.8 Paula J Schlemmer Balance Due: 47.00 746404 08/28/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Lauren N Searl Balance Due: 47.00 746404 08/28/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Brenda L Vance Balance Due: 47.00 luvoicc # 3949l9 (ooutiouud)page 2 Iuroico# 384Vl9Balance Due: ' 501.00 PLEASE REMIT PAYMENT PROMPTLY � | | / Cut and nmnwith 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 9/3/14 394919 Pre-employment drug testing $ 125.00 9/3/14 394919 Pre-employment drug testing $ 376.00 Total $ 501.00 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 d Voucher No. Warrant No. 355031 Community Occupational Health Services Allowed 20 7169 Solution Center Chicago, IL 60677-7001 In Sum of$ $ 501.00 r ON ACCOUNT OF APPROPRIATION FOR 101-GF-Nw2A--/ ICA MONON Ci�--NTFR PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members Dept# 1125 394919 4340700 $ 125.00 1 hereby certify that the attached invoice(s), or 1091 394919 4340700 $ 376.00 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 18-Sep 2014 $ 501.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund