244682 4 /29/2015 0'4+� 'Nf CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH 9109K AMOUNT: $"""'423.00'
4. ,a CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 244682
gMr[TON•uo• CHICAGO IL 60677-7001 CHECK DATE: 04/29/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 413867 376.00 MEDICAL FEES
1125 4340700 413867 47.00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Purchase eS Chicago, IL 60677-7001
Description ��Q- Phone: 317-621-0341
P.O.# P or F FEIN: 35-1955223zzCT
CPU �7F
G.L.
Budget t '1'zs-� �I APR 13 2015
Line Descr
Purchase DateBY:
Approv^ Date:%L (� Invoke
April 02, 2015
Bill to: Lynn Russell For: Carmel Clay Parks &Recreation
Carmel Clay Parks &Recreation 03/15
1411 E. 116th St.
Carmel, IN 46032-
Invoice# 413867
Proc Code ICD9 Date Description Q�t Charge Receipt Adiust Balance
746404 03/16/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Christian D Amaro Balance Due: 47.00
746404 03/25/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Brittany Berghus Balance Due: 47.00
746404 03/25/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Tara A Carte Balance Due: 47.00
_... _
....................... _. .. .._._. .. ....................
746404 03/12/2015 Drug Screen-Non MDA 5 Panel 1.00 47.00 47.00
Kyrsten Q Ford Balance Due: 47.00
............... ......................................._...................._.._.................__................
746404 1)920 03/25/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
2)E917.0
Italie R Griffin Balance Due: 47.00
746404 03/20/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Amy L Kranz Balance Due: 47.00 _
.......... __....... ........._..._.._.. ...._. .... __...... ......... .._._... .._._._._ ....................
746404 03/25/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Crystal Peters Balance Due: 47.00
..............................._....__.............._.... ...............__.._....._........_..................
746404 03/13/2015 DrugScreen-Non NIDA 5 Panel 1.00 47.00 47.00
Morsal Rasouli Balance Due: 47.00
746404 1)847.2 03/20/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
2)E927.0
Michelle S Yadon Balance Due: 47.00
_..... __.......... . ....
........... ........ ......... . .. ... ...........
Invoice# 413867 Balance Due: 423.00
PLEASE REMIT PAYMENT PROMPTLY
Invoice# 413867 (continued)page 2
.. Cut and return with payment
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
4/2/15 413867 Pre-employment drug testing $ 376.00
412115 413867 Pre-employment drug testing $ 47.00
TotalI$ 423.00
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
Voucher No. Warrant No. i
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 423.00
i
ON ACCOUNT OF APPROPRIATION FOR ;.
i
101 Generalfund/108 ESE
Po#or Board Members
Dept# INVOICE NO. CCT#/TITL AMOUNT
1081-99 413867 4340700 - ,$ 376.00 1 hereby'certify that the attached invoice(s), or
1125' 413867_ 4340700 $ 47.00 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
April 28, 2015
i
j 1
$ 423.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund