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CITY OF CARMEL, INDIANA VENDOR: 355031ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH�RVK AMOUNT: S 47.00CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 314161 CHICAGO IL 60677-7001 CHECK DATE: 07/31/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 496617 47.00 MEDICAL FEES
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
7/17/17 496617 Pre-Employment Drug Testing xx5652 $ 47.00
Total $ 47.00
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
, 20
Clerk-Treasurer
• Community Occupational Health Svs
R e y �7 D 7169 Solution Center
Chicago, IL 60677-7001
JUL ? 0 2011 Phone: 317-621-0341
FEIN: 35-1955223
BY:
Invoice
July 17, 2017
Bill to: Lynn Russell For: Carmel Clay Parks& Recreation
Carmel Clay Parks & Recreation 7/17
1411 E. 116th St.
Carmel, IN 46032-
Invoice # 496617
Proc Code Date Description QtY Charge Receipt Adiust Balance
746404 07/08/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Ke Shawn Shaffer Balance Due: 47.00
Invoice# 496617 Balance Due: 47.00
Please remit payment promptly
720 .17 G`I
Cut and return with payment