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HomeMy WebLinkAbout300819 07/21/16 a_��e a`% M'� CITY OF CARMEL, INDIANA VENDOR: 355031 ** ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH%kIItOK AMOUNT: $** ***675.00* �� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 300819 s���oN�� CHICAGO IL 60677-7001 CHECK DATE: 07/21/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 458736 423.00 MEDICAL FEES 1091 4340700 458736 47.00 MEDICAL FEES 1125 4340700 458736 205.00 MEDICAL FEES Voucher No. Warrant No. 355031 Community Occupational Health Services Allowed 20 7169 Solution Center Chicago, IL 60677-7001 In Sum of$ $ 675.00 ON ACCOUNT OF APPROPRIATION FOR 101 General/108 ESE /109 MCC PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1125 458736 4340700 $ 205.00 1 hereby certify that the attached invoice(s), or 1081-99 458736 4340700 $ 423.00 bill(s) is (are)true and correct and that the 1091 458736 4340700 $ 47.00 materials or services itemized thereon for which charge is made were ordered and received except July 12, 2016 1PACk&WX" Signature $ 675.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund _ Comrrmunity0ccupational'Health^Svs� SolctionxCenter �, Chicago, IL 606777,001L�,��n--, `62=1=0341''=r FEIN: 35-1955223 �C�f VE� JUL .11'2016 C�Q Invoice BY: Bill to: Lynn Russell For: Carmel Clay Parks &Recreation Carmel Clay Parks &Recreation 06/16 1411 E. 116th St. Carmel, IN 46032- _ InvoiceA!--'A5,8 73 6-,-r Proc Code ICD Date Description QtV Charge Receipt Adiust Balance 746404 06/30/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Ariel A Baker Alfeld Balance Due: 47.00 ...................................................... 746404 06/12/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Joseph N Dickson Balance Due: 47.00 746404 1) 06/16/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 S00.33XA 2) Y08.89XA James A Dowell Balance Due: 47.00 _....................................................._.__..........._........ ............._........................................-........ ............:.._.............. .............. 746404 1) 06/21/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 S61.001A 2)Y93.H2 John R Garman Balance Due: 47.00 . ........ . .... .__ ..... .... ... . . .... _ .... _... . ..... 746404 06/14/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Ashlin G Hair Balance Due: 47.00 .__ . _... .. _. ... __......_. ..... . ...... ....... . 746404 06/14/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Hannah M Klineman Balance Due: 47.00 _....._...._.._ ......._............ ........ ......_... _........ ............................... .........................._._.._.. .:.. 746404 06/18/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Stacey L Lee Balance Due: 47.00 746404 06/30/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Madison M Linkmeyer Balance Due: 47.00 ... ... ... .... .._.__ ... ........... 746404 06/10/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Riley Smith Balance Due: 47.00 _ ...._.........._......... ......_ _........ .... ... ... . ..... ............_ . ....... . . ._..._ . .... 746404 06/17/2016 Drug Screen-Non MDA 5 Panel 1.00 47.00 47.00 Lillian StAngelo Balance Due: 47.00 m jnv6ice#---458736 (continued)page 2 746404 06/29/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jake M Stauffer Balance Due: 47.00 ---_-_._....._....--.___._.....__.....__.._._....._.. - ..................__._.._....._._........_._._...._..--._....... _._ 746404 06/21/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 82075 06/21/2016 Breath Alcohol Test 1.00 32.00 32.00 746404 06/27/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 82075 06/27/2016 Breath Alcohol Test 1.00 32.00 32.00 Neil P Whitehead Balance Due: 158.00 Invoice# 458736 Balance Due: 67r50U PLEASE NOTE: Effective 6/1/16 there will be a fee increase for a select set of services