241483 01/27/15 i u�_C.INb
CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH WA9K AMOUNT: S*******188.00*
a CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 241483
9M«oN, CHICAGO IL 60677-7001 CHECK DATE: 01/27/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 405852 188.00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center _
Chicago, IL 60677-7001
Phone: 317-621-0341 I
FEIN: 35-1955223 JAN 0 9. 2015
BY:
JAN 1,9 2015
Invoice BY:
January 05, 2015 —`—
Bill to: Lynn Russell For: Carmel Clay Parks &Recreation
Carmel Clay Parks &Recreation 12/14
1411 E. 116th St.
Carmel, IN 46032-
__._.._..___..__ _._._._..._..__._.._.._..___....._...._.........__________.__......._._.___.v.._..__.___....____.._._.___.____..._.________...._.__...._......__._.____. ------
Invoice
_.__
Invoice# 405852
Proc Code Date Description 9-!Y Charge Receipt Adiust Balance
746404 12/16/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Tinara L Davis Balance Due: 47.00
746404 12/29/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Basel G Maarouf Balance Due: 47.00
746404 12/15%2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Luisa M Perez Berrio Balance Due: 47.00
746404 12/19/2014 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Julie Sparkr Balance Due: 47.00
Invoice# 405852 Balance Due: 188.00
PLEASE REMIT PAYMENT PROMPTLY
Purchase
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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
1/5/15 405852 Pre-employment drug testing $ 188.00
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 I C 5-11-10-1.6
,20
Clerk-Treasurer
it
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
4 In Sum of$
$ 188.00
i
' ON ACCOUNT OF APPROPRIATION FOR
108 ESE
I
PO#or Board Members
INVOICE NO. ACCT#/TITL AMOUNT
Dept#
1081-99 405852 4340700 $ 188.00 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
January 22, 2015
$ 188.00 I Accounts Payable Coordinator
Cost distribution ledger classification if i Title
claim paid motor vehicle highway fund
i