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Home My WebLink About259260 06/03/16 %'a�n�• CITY OF CARMEL, INDIANA VENDOR: 355031 ® � ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH 910%AMOUNT: $.....**564.00* :: _�; CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 259260 9M,�TON_�° CHICAGO IL 60677-7001 CHECK DATE: 06/03/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 454519 564.00 MEDICAL FEES Voucher No. Warrant No. 355031 Community Occupational Health Services Allowed 20 7169 Solution Center Chicago, IL 60677-7001 In Sum of$ $ 564.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members Dept# 1081-99 454519 4340700 $ 564.00 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 May 25, 2016 1PA0AW%XA) Signature $ 564.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund `-CommunitM.b.6pab6 fti 'ealth SVS -� �71y69 Solutiom,Center ' i 4Chicago, IL�6`067a7t7001yT fi aa: Phone�3p121.'Q341';?;� FEIN: 35-1955223 � i�x M,AY 9 Invoice -- �1VIay`1�3, Bill to: Lynn Russell For: Carmel Clay Parks &Recreation Carmel Clay Parks &Recreation 5/16 1411 E. 116th St. Carmel, IN 46032- 7 r Proc Code Date Description QtV Charge Receipt Adjust Balance 746404 05/04/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Anna M Atkinson Balance Due: 47.00 746404 05/09/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 David Bergsma Balance Due: 47.00 746404 05/09/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Lucy Cottrell Balance Due: 47.00 746404 05/04/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00` 47.00 Kevin M Fleming Balance Due: 47.00 746404 05/05/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Rebecca J Fooksman Balance Due: 47.00 746404 05/07/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Evelyn K Ford Balance Due: 47.00 746404 05/06/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Timothy A Foster Balance Due: 47.00 _......__.........................__......._......_..................................................................-.._......._..._..._........... 746404 05/10/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jessica R Hanes Balance Due: 47.00 . . ......... .._... .. ..._ .... .. . . ....I .. .. ........ . ... ..... _ . .. . 746404 05/03/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Hansen Huber Balance Due: 47.00 746404 05/10/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Adeline C Lange Balance Due: 47.00 746404 05/07/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Abigail E Paul Balance Due: 47.00 _. . ... .. . ..... .... . .. _ _. 746404 05/12/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Invoice# 454519 (continued)page 2 Grant Wood Balance Due: 47.00 Invoice# 454519 Balance Due. 41g5jO.J0 PLEASE NOTE: Effective 6/1/16 there will be a fee increase for a select set of services