243184 3 /18/2015 CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CUROK AMOUNT: $********94.00*
s9 i° CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 243184
CHICAGO IL 60677-7001 CHECK DATE: 03/18/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 411696 94.00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
MAR 0 9 2015 FEIN: 35-1955223
LB:,
Invoice
March 03, 2015
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks &Recreation 2-15
1411 E. I I 6th St.
Carmel, IN 46032-
Invoice 4 411696
..........
Proc Code Date Description Qty Char_qe Receip Adius Balance
746404 02/22/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Terese M McAninch Balance Due: 47.00
746404 02/18/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
4107105
Heather L Nielsen Balance Due: 47.00
Invoice# 411696 Balance Due: 94.00
PLEASE REMIT PAYMENT PROMPTLY
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Approval V Date
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
3/3/15 411696 Pre-employment drug testing $ 94.00
Total $ 94.00
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with I C 5-11-10-1.6
, 20
Clerk-Treasurer
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Voucher No. Warrant No.
355031 Community Occupational Health Servic 's Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 94.00 I
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ON ACCOUNT OF APPROPRIATION FOR j
108 ESE
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PO#or INVOICE NO. CCT#/TITL AMOUNT I Board Members
Dept#
1081-99 411696 4340700 $ 94.00 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
March 12, 2015
i
$ 94.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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