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240653 01/07/15 ��'Coq* CITY OF CARMEL, INDIANA VENDOR: 355031 ® =1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTHPaldAOK AMOUNT: $""'"'752.00' } CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 240653 9y�,r(N.o,r, CHICAGO IL 60677-7001 CHECK DATE: 01/07/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 399400 47.00 MEDICAL FEES 1081 4340700 399418 188.00 MEDICAL FEES 1081 4340700 402974 423.00 MEDICAL FEES 1125 4340700 402974 47.00 MEDICAL FEES 1081 4340700 405059 47.00 MEDICAL FEES Community Occupational Health Svs P"'c ''se /i�E-fG�'Y'Y��T 7169 Solution Center \ C�c„cripiion c[l.�%U l— Chicago, IL 60677-7001 �� )-- -`�f�F Phone: 317-621-0341 ;�r P° F FEIN: 35-1955223 c.L.� 113!to 7o n io$l-r� DEC - 2014 line'Dascr � BY: rchaser Dr*e Date Invoice October 15, 2014 Bill to: Lynn Russell For: Alan Dancy Cannel Clay Parks & Recreation 10-14 1411 E. 1 16th St. Cannel, IN 46032- Invoice# 399400 Proc Code Date Description Qty Charge Receipt Adiust Balance 746404 10/06/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Alan W Dancy Balance Due: 47.00 Invoice# 399400 Balance Due: 47.00 PLEASE REMIT PAYMENT PROMPTLY Community Occupational Health Svs 7169 Solution Center R+;rcllaseChicago, IL 60677-7001 �- ��/ J C- -:,rition uL L Phone: 317-621-0341 P.O.# — tl or F FEIN: 35-1955223 777 c.L.# `99- y3 7y CjB4O-?t Lina CescrPurchaser Date ]B� Appi,a DateInvoice October 15, 2014 Bill to: Lynn Russell For: Cannel Clay Parks & Recreation Cannel Clay Parks & Recreation 10-14 1411 E. 116th St. Cannel, IN 46032- Invoice# 399418 Proc Code Date Description QtV Charge Receipt Adjust Balance 746404 10/07/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Nicole S Carman Balance Due: 47.00 746404 10/07/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Anthony W England Balance Due: 47.00 746404 10/06/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Taylor A Smith Balance Due: 47.00 746404 10/06/2014 Drug Scrcen-Non NIDA 5 Panel 1.00 47.00 47.00 Kevin Toney Woods Balance Due: 47.00 Invoice# 399418 Balance Due: 188.00 PLEASE REMIT PAYMENT PROMPTLY Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 _ 1'cr F Phone: 317-621-0341 r�- ,� FEIN: 35-1955223 ��r, DEC - g 2014 -�'- - BY: q7 co Invoice IDI�1- 99 W3. December 02, 2014 Bill to: Lynn Russell For: Cannel Clay Parks & Recreation Carmel Clay Parks & Recreation 11/14 1411 E. 116th St. Carmel, IN 46032- Invoice # 402974 Proc Code Date Description QtV Charge Recei t Adiust Balance 746404 11/20/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Mark W Carter Balance Due: 47.00 746404 11/12/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Samantha O Cruz Balance Due: 47.00 746404 11/22/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Taryn M Ford Balance Due: 47.00 746404 11/21/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Halie R Griffin Balance Due: 47.00 746404 11/28/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Sydney M Grubb Balance Due: 47.00 746404 11/24/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Christine Y Johnson Balance Due: 47,00 746404 11/07/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Brent A McElhany Balance Due: 47.00 746404 11/23/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 �.Camille;NNelsenABalance Due:;•. .47.00;:. 746404 11/12/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jamie A Strong Balance Due: 47.00 746404 11/24/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Patricia T Washam Balance Due: 47.00 Invoice# 402974 Balance Due: 470.00 PLEASE REMIT PAYMENT PROMPTLY Community Occupational Health Svs =BY: 7169 Solution CenterChicago, IL 60677-7001Phone: 317-621-0341FEIN: 35-1955223 Invoice December 15, 2014 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Carmel Clay Parks & Recreation 12/14 .1411 E. 1 16th St. Carmel, IN 46032- Invoice# 405059 Proc Code ICD9 Date Description QQt r� Charge Receipt Adjust Balance 746404 1)326.0 12/05/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 2)924.3 Monica E Haddock Balance Due: 47.00 Invoice# 405059 Balance Due: 47.00 PLEASE REMIT PAYMENT PROMPTLY Purchase _ D scription � P.O.# PorF G.L.# Budget Line Descr 1S Purchas A LoDate Approv ate-55-5/1 L 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 10/15/14 399400 Pre-employment drug testing $ 47.00 10/15/14 399418 Pre-employment drug testing $ 188.00 12/2/14 402974 Pre-employment drug testing $ 47.00 12/2/14 402974 Pre-employment drug testing $ 423.00 12/15/14 405059 Pre-employment drug testing $ 47.00 Total $ 752.00 1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 120 Clerk-Treasurer Voucher No. Warrant No. 355031 Community Occupational Health Services Allowed 20 7169 Solution Center Chicago, IL 60677-7001 In Sum of$ $ 752.00 ON ACCOUNT OF APPROPRIATION FOR 101 General / 108 ESE PO#or INVOICE NO. ACCT WTITLE AMOUNT Board Members Dept# 1081-99 399400 4340700 $ 47.00 1 hereby certify that the attached invoice(s), or 1081-99 399418 4340700 $ 188.00 bill(s) is(are)true and correct and that the 1125 402974 4340700 $ 47.00 materials or services itemized thereon for 1081-99 402974 4340700 $ 423.00 which charge is made were ordered and 1081-99 405059 4340700 $ 47.00 received except January 2, 2015 $ 752.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund