249645 09/23/15 F CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%1809K AMOUNT: $*******658.00*
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 249645
ey,bN Lo, CHICAGO IL 60677-7001 CHECK DATE: 09/23/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 429067 658.00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center �
Chicago, IL 60677-7001 -E` VEI
Phone: 317-621-0341
FEIN: 35-1955223 SEP 0 9 2015
TBE Y:
Invoice
September 02, 2015
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks & Recreation 08/15
1411 E. 116th St.
Carmel, IN 46032-
.._..._._._._ ._ _... .__...�....____....___ Invoice.# rv_429067 .�....�.�.__ __..�..�...
Proc Code ICD9 Date Description QQt i� Charge Receipt Adjust Balance
746404 1)892.0 08/19/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
2) E918
Tinara L Davis Balance Due: 47.00
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746404 1)914.0 08/18/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
2)E968.8
Eden Gill Balance Due: 47.00
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746404 08/31/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Susan Heckaman Balance Due: 47.00
--------------- ------------------------------------------ --------------------------------------------------------
746404 08/24/2015 DrugScreen-Non NIDA 5 Panel 1.00 47.00 47.00
Megha Juneja Balance Due: 47.00
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746404 08/24/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Rachel H Kasper Balance Due: 47.00
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746404 08/19/2015 Drug-Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Theresa J Levine Balance Due: 47.00
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746404 08/19/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Mackenzie N Matters Balance Due: 47.00
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746404 08/24/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Emily K Perry Balance Due: 47.00
------------------------------ ------------- ------ ------ --------------------------------------------------------
746404 08/19/2015 DrugScreen-Non NIDA 5 Panel 1.00 47.00 47.00
Rita A Pierce Balance Due: 47.00
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746404 08/24/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Sharon K Rusk Balance Due: 47.00
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746404 08/31/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Elizabeth D Silvers Balance Due: 47.00
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Invoice # 429067 (continued)page 2
746404 08/20/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Brandon A Smith Balance Due: 47.00
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746404 08/24/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Francesca M Smith Balance Due: 47.00
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746404 08/24/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Alexander J Starkey Balance Due: 47.00
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Invoice# 429067 Balance Due: 658.00
PLEASE REMIT PAYMENT PROMPTLY
ESE8 2015
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
912115 429067 Pre-employment drug testing $ 658.00
Total $ 658.00
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$
$ 658.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-99 429067 4340700 $ 658.00 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
September 17, 2015
$ 658.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund