248283 08/12/15 a`% p CITY OF CARMEL, INDIANA VENDOR: 355031
= °' ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%I!RVK AMOUNT: $********47.00*
;j�; CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 248283
.y��TON�°. CHICAGO IL 60677-7001 CHECK DATE: 08/12/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 424474 47.00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223 '
JUL 10 2015
BY
Invoice
July 02, 2015
Bill to: Lynn Russell For: CarmelY Clay Parks &Recreation
Carmel Clay Parks &Recreation 06/15
1411 E. 116th St.
Carmel, IN 46032-
Invoice# 424474
Proc Code ICD9 Date Description QQt i� Charqe Receipt Adjust Balance
746404 1)924.3 06/25/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
2)826.0
Oluseun M Kayode Balance Due: 47.00
Invoice# 424474 Balance Due: 47.00
PLEASE REMIT PAYMENT PROMPTLY
_ 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
7/2/15 424474 Pre-employment drug testing $ 47.00
Total $ 47.00
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
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 47.00
I
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or Board Members
Dept# INVOICE NO. ACCT#/TITL AMOUNT
1081-99 424474 4340700 $ 47.00 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
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August 6, 2015
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$ 47.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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