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