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251037 11/04/15 r Coq'- ,f CITY OF CARMEL, INDIANA VENDOR: 355031 ® it ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH ISIdRQK AMOUNT: $.....**658.00* CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 251037 'MrroN�. CHICAGO IL 60677-7001 CHECK DATE: 11/04/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 432028 470.00 MEDICAL FEES 1081 4340700 433600 47.00 MEDICAL FEES 1081 4340700 433967 141.00 MEDICAL FEES I ' Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice October 02, 2015 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Carmel Clay Parks & Recreation 09/15 1411 E. 116th St. Carmel, IN 46032- Invoice # 432028 Proc Code Date Description QtV Charge Receipt Adiust Balance 746404 09/30/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Audrey Barnard Balance Due: 47.00 746404 09/16/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Stevie A Cupp Balance Due: 47.00 746404 09/17/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Mattie I Habig Balance Due: 47.00 746404 09/12/2015 Drug Screen- Non NIDA 5 Panel 1.00 47.00 471.00 Judith L Hillyer Balance Due: 47.00 746404 09/16/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Joshua P Horowitz Balance Due: 47.00 746404 09/16/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Johnna K Isbell Balance Due: 47.00 746404 09/25/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Lucille Jones Balance Due: 47.00 746404 09/30/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Heather L Lopez Balance Due: 47.00 746404 09/12/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Caleb L Sullivan Balance Due: 47.00 746404 09/30/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Katelyn E Summitt Balance Due: 47.00 Invoice# 432028 Balance Due: 470.00 PLEASE REMIT PAYMENT PROMPTLY Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice October 02, 2015 Bill to: Lynn Russell For: Cannel Clay Parks & Recreation Carmel Clay Parks & Recreation 9-15 House 1411 E. 116th St. Carmel,IN 46032- Invoice# 433600 Proc Code Date Description QtV Charge Receipt Adiust Balance 746404 09/01/2015 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Shynea L House Balance Due: 47.00 Invoice# 433600 Balance Due: 47.00 PLEASE REMIT PAYMENT PROMPTLY Community Occupational Health Svs _ 7169 Solution Center Chicago, IL 60677-7001 RECEIVED Phone: 317-621-0341 FEIN: 35-1955223 OCT 2 3 2015 BY: Invoice October 15, 2015 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Carmel Clay Parks & Recreation 10/15 1411 E. 1 16th St. Carrel, IN 46032- Invoice # 433967 Proc Code Date Description QQt i� Charge Receipt Adjust Balance 746404 10/01/2015 Drug Screen-Nun NIDA 5 Pancl 1.00 47.00 47.00 Olusayo A Banjo Balance Due: 47.00 746404 10/01/2015 Drug Screcn -Non NIDA 5 Panel 1.00 47.00 47.00 Florence G Fahnbulleh Balance Due: 47.00 746404 10/06/2015 Drug Screcn- Non NIDA 5 Panel 1.00 47.00 47.00 Caitlin E Stahl Balance Due: 47.00 Invoice# 433967 Balance Due: 141.00 PLEASE REMIT PAYMENT PROMPTLY CO—s=.. Cut and retum with payment ------------------------------------------------------------ Please remit 141.00 to Community Occupational Health Services 7169 Solution Center Please place invoice number 433967 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 10/2/15 432028 Pre-employment drug testing $ 470.00 10!2/15 433600 Pre-employment drug testing $ 47.00 10/15/15 433967 Pre-employment drug testing $ 141.00 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 5-11-10-1.6 120 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 432028 4340700 $ 470.00 1 hereby certify that the attached invoice(s), or 1081-99 433600 4340700 $ 47.00 bill(s) is (are)true and correct and that the 1081=99 433967 4340700 $ 141.00 materials or services itemized thereon for which charge is made were ordered and received except October 28, 2015 1P kmblyy�� Signature $ 658.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund