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CITY OF CARMEL, INDIANA VENDOR: 355031
d it ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH e,18RQK AMOUNT: $********47.00*
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 252585
'"ccoa CHICAGO IL 60677-7001 CHECK DATE: 12/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 4138963 47.00 MEDICAL FEES
h Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001 R-E-CE1V' D
Phone: 317-621-0341
FEIN: 35-1955223 DEC - 7 2015
BY:
Invoice
December 02, 2015
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks & Recreation 11115
1411 E. 1 16th St.
Cannel, IN 46032-
Invoice # 438963
I
Proc Code Date Description QtV Charge Receipt Adjust Balance
746404 11/23/2015 Drug Screcn-Non NIDA 5 Panel 1.00 47.00 47.00
Olivia NI Turi Balance Due: 47.00
Invoice# 438963 Balance Due: 47.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and retuni with payment
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I
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
12/2/15 438963 Pre-employment drug testing $ 47.00
Total $ 47.00
I 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$
$ 47.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept.#
1081799 438963 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
December 10, 2015
Signature
$ 47.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund