243921 04/08/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%WR9K AMOUNT: S"`"•"266.00'CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 243921
CHICAGO IL 60677-7001 CHECK DATE: 04/08/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 412571 188.00 MEDICAL FEES
1125 4340700 412571 78.00 MEDICAL FEES
Community Occupational Health Svs _.
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
MAR 2 0 2015
Invoice `�"��
March 16, 2015
Bill to: Lynn Russell For: Carmel Clay Parks &Recreation
Carmel Clay Parks & Recreation 03/15
1411 E. 116th St.
Carmel, IN 46032-
Invoice# 412571
Proc Code Date Description QtV Charge Receipt Adiust Balance
746404 03/01/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
82075 03/01/2015 Breath Alcohol Test 1.00 31.00 31.00
Andrew W Burnett Balance Due: 78.00
746404 ._ 03/11/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00-. -
Javier A Colon Balance Due: 47.00
746404 03/05/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Benjamin N Hatfield Balance Due: 47.00
746404 03/11/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Austin Mays Balance Due: 47.00
746404 03/03/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Thomas L Moorman Balance Due: 47.00
Invoice# 412571 Balance Due: 266.00
Purchase r�, - z PLO�ix r PLEASE REMIT PAYMENT PROMPTLY
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Budget 79.
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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
3/16/15 412571. Pre-employment drug testing $ 188.00.
3/1.6/15 412571 Pre-employment drug testing $ 78.00
Total $ 266.00
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
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Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
7169 Solution Center j
Chicago, IL 60677-7001
In Sum of_$
$ 266.00.
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ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
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Board Members
PO#or INVOICE NO. ACCTWTITL AMOUNT
Dept#
1081-99 412571 4340700 $ 188.00 1 hereby certify that the attached invoice(s), or
1125 412571 4340700 $ 78.00. bill(s)is(are)true and correct and that the
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materials or services itemized thereon for
iwhich charge is made were ordered and
received except
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April 2, 2015
1P
$ 266.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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