HomeMy WebLinkAbout247804 07/28/15 o",
CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH% ROK AMOUNT: $*******223.00*
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 247804
CHICAGO IL 60677-7001 CHECK DATE: 07/28/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4239099 19188 98.00 OTHER MISCELLANOUS
1081 4340700 425266 47.00 MEDICAL FEES
1125 4340700 425266 78.00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341 �T_�� ` c
FEIN: 35-1955223 1
JUL 2 0 2015 I
B�'
Invoice
July 15, 2015
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks & Recreation 07/15
1411 E. 116th St.
Carmel, IN 46032-
Invoice # 425266
Proc Code Date Description Qty Charge Receipt Adjust Balance
746404 07/08/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
82075 07/08/2015 Breath Alcohol Test 1.00 31.00 31.00
John R Alelcsa Balance Due: 78.00
746404 07/09/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Jennifer L Lafary Balance Due: 47.00
Invoice# 425266 Balance Due: 125.00
PLEASE REMIT PAYMENT PROMPTLY
Purchase
D ascription
P.O.# P or F
G.L.#
B:s��wet
Unebescr
Purchaser Date
Approval 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
7/15/15 425266 Pre-employment drug testing $ 78.00
7/15/15 . 425266.. Pre-employment drug testing $ 47.00
Total $ 125.00
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.
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 125.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund/108 ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 425266 4340700 $ 78.00 1 hereby certify that the attached invoice(s), or
1081-99 425266 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
July 23, 2015
$ 125.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
Invoice
July 02, 2015
Bill to: Jim Spelbring For: Carmel Street Dept.
Cannel Street Dept. 6/15
1 Civic Square
Cannel,IN 46032-
Invoice# 423779
Proc Code Date Description Qty Charge Receipt Adjust Balance
06/16/2015 Respirator Fit Test 1.00 49.00 49.00
Evie NI Anderson XXX-XX-7323 Balance Due: 49.00
06/16/2015 Respirator Fit Test 1.00 49.00 49.00
Lynette A Hobbs XXX-VX-2503 Balance Due: 49.00
Invoice# 423779 Balance Due: 98.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and return with payment
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))
07/02/15 423779 $98.00
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
$98.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
i
2201 I 423779 I 42-390.991 $98.00 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
which charge is made were ordered and
received except
Th� sday J y 23, 2015
U"
Street Commissio4
C�°trao# C'!r.rtmio5sit�nAr
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund