242503 02/24/15 CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH Q!AOK AMOUNT: $********47.00*
r, ? CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 242503
9M(T�N�p CHICAGO IL 60677-7001 CHECK DATE: 02/24/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4341999 409675 47.00 OTHER PROFESSIONAL FE
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
Invoice
February 03, 2015
Bill to: Jim Spellbring For: Carmel Police Department
Cannel Police Department 1115
1 Civic Square
Cannel, IN 46032-
..__...... .... ._. ........ . ._. _.. .. . . . ...._._... ... _. .
Invoice # 409675
Proc Code ICD9 Date Description Qty Charge Receipt Adjust Balance
80101 1)923.03 01/31/2015 NON-NIDA 5 Panel UDS 1.00 47.00 47.00
2) ES 19.0
Aaron M Leach XXX-XX-5869 Balance Due: 47.00
Invoice# 409675 Balance Due: 47.00
PLEASE REMIT PAYMENT PROMPTLY
Submitted To
FEB 16 2015
Clerk 7'reesurer
Cut and return with payment
O�_-_ -
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))
02/03/15 409675 blood draw-Leach $47.00
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
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Community Occupational Health Services
IN SUM OF $
7169 Solution Center
Chicago, IL 60677-7001
$47.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 409675 43-419.99 $47.00
I hereby certify that the attached invoice(s), or
I I
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
Thursday, F bruary 19, 2015
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund