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259894 06/24/16
1y:'.4@nyf CITY OF CARMEL, INDIANA VENDOR: 355031 ® ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH ROK AMOUNT: $*****1,175.00* CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 259894 9M�r6N"F°� CHICAGO IL 60677-7001 CHECK DATE: 06/24/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 455313 1,175.00 MEDICAL FEES Voucher No. Warrant No. 355031 Community Occupational Health Services Allowed 20 7169 Solution Center Chicago, IL 60677-7001 In Sum of$ $ 1,175.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1081-99 455313 4340700 $ 1,175.00 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 June 15, 2016 IPACOJM�� Signature $ 1,175.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund Proc Code IQQ Date Description Qty Charge Receipt 8dLu s t Balance 746404 05/21/2010 Drug Screen'Non NIDA 5Panel 1.00 47.00 47.00 �uvv�� ��oduUD�oluooe]0oe; ----------- � 47.00 746404 05/17/2016 Drug Screen Non NIDA 5Panel lOO 47OO ---------- � � 47.00 Matthew L]0urutboouwBalance Due: 746404 05/15/2016 Drug Screen'Nony«lDA 5Puou\ 100 47.0O --------�-- 47.00 Jasmin N Childress Balance Due: 47.00 746404 05/19/2010 Drug Screen-Non NIDA 5Panel 1.00 47.00 47.00 8uuu Cook Balance Due: ----------' 47'O0 746404 05D0/2016 Drug Screen Non NIDA 5yuno| } O0 47OO ----------- � . 47.00 Jack E Cunningham Balance Due: 47.00 746404 740404 05/13/2016 Drug Screen Non NIDA 5Panel | 0O 47OO ----------' � � 47.00 Christopher BDeputy Balance]0oe'Due: 47.00 47'0O 746404 05/19/2016 Drug Screen'Non NIDA 5Panel | OO 47OO ----------' � . 47.00 Eomfly EcDJBalance]0ne' ----------' ' 47.00 746404 05/25/2010 Drug Screen'Non NIDA 5Panel | OO 4?OO ----------- ' . 47.00 Steven IGoedduBalance]0oe' ----------' ' 47.00 746404 05/13D016 Drug Screen'Non N)DAxPanel 1.00 47.0O ---------- � , 47.00 "Cordo Gromo]0u}uoce0om' ---------- ' 47'0O 740404 05/16/2010 Drug Screen'Non NIDA 5yune) 1.00 47�0O -------�-� ` 47.00 Mary Habig Balance]0o*' -�---�---- ' 47.00 746404 05/14/2016 Drug Screen'Non NIDA 5Panel 1.00 47.00 ---------- 47.00 Sara CHighers Balance]0oc'Due: 47.00 47'0O 746404 05/17/2016 Drug Screen'Non NIDA 5Panel 1.00 47.00 ---------- 47.00 W77 ����� Kimberly 8Howse Balance Due: 47.00 ------- 740404 05/20/2016 DrugSurenn-Nooy«lDA 5Punnl 1.00 47.00 4780 Madison Jacobs Balance Dow' ----------- ' 47'00 746404 05/19/2016 Drug Screen'Non NIDA 5Panel \.00 47.00 47.00 Sophie GLongest Balance Due: 47.00 ---------' 746404 05/14/2016 Drug Screen'Non NIDA 5Panel 1.00 47.00 47.00 KaltlyuB Luczak Balance Due: 47.00 746404 05/14D016 Drug Screen'Non NIDA 5Panel 1.00 47.00 47.00 Bryce I.Peters Balance Due: 47.00 ----------- 746404 ---05/-16/2016--Drug Screen-Non NIDA 5 Panel- |.00 4-7-.00 - - -4700- lJoueuN Peters Balance Due: 47.00 746404 740404 05/18/2016 Drug Screen'Non NIDA JPanel 1.00 47.00 47.00 740404 l) 05/26/2016 Drug Screen'Non NIDA 5Puuel 1.00 47.00 47.00 W80.8}{X A Sara BiRust Balance]0oe' ---------- ' 04'00 740404 05/20/2010 Drug Screen'Non NIDA 5Panel 1.00 47.00 47.00 Gabriela CSeal Balance l0oe' ---------- ' 47'00 746404 05/14/2016 Drug Screen'Non NIDA 5Panel 1.00 47.00 47.00 Elizabeth MSheridan Balance Due: ----------- 47'O0 ----------' 746404 05/07D016 Drug Screen'Non NIDA 5Panel 1.00 47.00 47.00 Jordan EToby Balance]0oe' ----------' ' 47.00 746404 05/21/2016 Drug Screen'Non NIDA 5 Panel 1.00 47.00 47.00 %obyu lDduyuoBalance l0ow' ---------- ' 47'O0 746404 0511 O5/l.7/2016 Drug Screen'Non NIDA 5Panel |.00 47.00 47.00 Courtney Ullman Balance 0oe' ----------- ' 47.00 746404 05/14/2010 Drug Screen'Non NIDA 5Panel \.00 47.00 47.00 Rachael LZimmer Balance Due: ----------- 47.O0 Dovuicw# 485313Balance Due: PLEASE NOTE: Effective d/l/l6there will bcafee increase for oselect set ofservices cmand�umwmpannom �b~=y�__--------------_____________________ _______________________ _________________________________ Please remit l,l75.0Oto Community Occupational Health Services 7l60Solution Center Please place invoice number 45G3l3oocheck Chicago,IL 60677'7001 9booc: 317'621'0341