242708 03/03/15 0al ��"� CITY OF CARMEL, INDIANA VENDOR: 355031
j ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH PatjR9K AMOUNT: $......**172.00*
s. Via. CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 242708
9.y��oN�. CHICAGO IL 60677-7001 CHECK DATE: 03/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4341999 389148 31.00 OTHER PROFESSIONAL FE
1061 4340700 409936 141.00 MEDICAL FEES
Community Health 8vo
Occupational
' 7109Solution Center
Chicago, IL 00677-7001
Phone: 317-021-0341
FEIN: 35-1855223 FEB 2 0 20157BY:
Invoice
�
February 13, 2015
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Bill to: Lynn Russell For Carmel Clay Parks 8tRecreation
Carmel Clay Parks &:Recreation 2/15
l4ll ]B. 116th St.
Carmel, IN 6
_ -------_-------__' -------
Invoice
-_
Iuvoice# 409936
| ---- -------------------- ------------ ---------�--------------------------'-----------------'---'
- -- -- '-- ----
Proc Code Date Description Qty Chame Receip 8&—St Balance
746404 0204/2015 Drug Screen'Non NIDA 5vuod \.00 47.00 47.00
��uDor�^�08urcnI�uluocw0om; -----------
47.00
� -_-------_-
� 746404 02/03/2015 Dmg3o�en'Non NIDA 5Pun� 1.00 47.00 47.00
----------'
' Bradley Miller Balance Due: 47'00
^
746404 02/05/2015 02/05/20l5 DmgScreen'Non NIDA 5Panel 1.00 47.00 47.00
Bfuooub Perkins Balance]0oe' ----------
' 47'0O
Iovutce# 4O9036Balance De: ----------
Due: l4l'O0
=====
PLEASE REMIT PAYMENT PROMPTLY
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oonpnan
P or
G.L.#
Pudget
Une,Des
Purchase Date
Approval Date—al 31/s
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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
2/13/15 409936 Pre-employment drug testing $ 14.1:.00
Total $ 141.00
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
i
Voucher No. Warrant No.
i
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
fIn Sum of$
141.00
'ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. CCT#lTITL AMOUNT Board Members
Dept#
1081-99 409936 4340700 $. 141.00- 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
I which charge is made were ordered and
/ received except
February 26, 2015 .
j 1p,
$ 141.00. Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
j
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
Invoice VAZT DUE .
July 02, 2014
Bill to: Barb Lem For: Carmel Police Department
Carmel Police Department 6/14
1 Civic Square
Carmel, IN 46032-
Invoice# 389148
Proc Code Date Description QtV Charge Receipt Adiust Balance
82075 06/18/2014 Breath Alcohol Test 1.00 31.00 31.00
Steven Cash XXX-X; 1 Balance Due: 31.00
Invoice# 389148 Balance Due:. 31.00
PLEASE REMIT PAYMENT PROMPTLY
�I
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
i
$31.00
i
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Prior Year I hereby certify that the attached invoice(s), or
1110 389148 43-419.99 $31.00
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
Thursday, February 26, 2015
:I'dw—
Chief of Police
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.
i
Terms
I
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
07/02/14 389148 breath alcohol test-Cash $31.00
I
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