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Home My WebLink About248772 08/26/15 ;• . CITY OF CARMEL, INDIANA VENDOR: 355031 ® 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%IORQK AMOUNT: $*******282.00* ?� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 248772 CHICAGO IL 60677-7001 CHECK DATE: 08/26/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 426662 235.00 MEDICAL FEES 1110 4341999 427603 47.00 OTHER PROFESSIONAL FE Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice August 04, 2015 Bill to: Jim Spellbring For: Carmel Police Department Carmel Police Department 7-15 1 Civic Square Cannel, IN 46032- Invoice# 427603 Proc Code ICD9 Date Description QtV Charge Receipt Adiust Balance 80101 1)883.0 07/13/2015 NON-NIDA 5 Panel UDS 1.00 47.00 47.00 2)V 15.85 John R Elliott XXX-XX-9123 Balance Due: 47.00 Invoice# 427603 Balance Due: 47.00 PLEASE REMIT PAYMENT PROMPTLY 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)) 08/04/15 427603 blood draw $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 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 $47.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 427603 43-419.99 $47.00 I hereby certify that the attached invoice(s), or I 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 Thursday, August 20, 2015 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 � �� FEIN: 35-1955223 AUG 13 2015 t ��': Invoice August 04, 2015 Bill to: Lynn Russell For: Cannel Clay Parks & Recreation Cannel Clay Parks & Recreation 07/15 1411 E. 116th St. Cannel, IN 46032- �� .__...�..-.. Invoice # 426662 Proc Code ICD9 Date Description QQt V Charge Receipt Adiust Balance 746404 07/24/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Allison E Cipriano Balance Due: 47.00 746404 1)720.0 07/22/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 2)E927.0 Kara L Decker Balance Due: 47.00 746404 07/31/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Raven N Hamilton Balance Due: 47.00 746404 07/24/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Kevin A Nicholas Balance Due: 47.00 746404 07/26/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Cameron A Pauley Balance Due: 47.00 Invoice# 426662 Balance Due: 235.00 PLEASE REMIT PAYMENT PROMPTLY Cut and returnwith payment Please remit 235.00 to Community Occupational Health Services 7169 Solution Center Please place invoice number 426662 on check Chicago; IL 60677-7001 Phone: 317-621-0341 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 8/4115 426662 Pre-employment drug testing $ 235.00 Total $ 235.00 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 �I In Sum of$ $ 235.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1081-99 426662 4340700 $ 235.00 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 August 21, 2015 $ 235.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund