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Home My WebLink About327194 07/10/18 .,y W-�AgyF ,;r CITY OF CARMEL, INDIANA VENDOR: 367222 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $**""1,939.15' s, _�: CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 327194 9M?FgN.c°. CHICAGO IL 60686-0020 CHECK DATE: 07/10/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 763559 1,001.00 TESTING FEES 1205 4347500 763573 938.15 GENERAL INSURANCE VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ CITY OF CARMEL 2046 RELIABLE PKWY An invoice or 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. CHICAGO, IL 60686-0020 Payee $938.15 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR General Administration Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 763573 43-475.00 $938.15 1 hereby certify that the attached invoice(s),or 6/30/18 763573 $938.15 1205 101 1205 101 bill(s)is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Thursday,July 5,2018 CA-4 c'.� Crider,James Administration I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 ,20 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-TreaSurer Indiana University Health Workplace Services,LLC 714 N.Senate Avenue Suite 200 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice June 30, 2018 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite EAP Services/June 2018 1 Civic Square Carmel,IN 46032- Invoice# 763573 Service Date Description Quanti Charge Recei Ad"Us Balance 06/01/2018 EAP Services 647.00 938.15 938.15 CITYCARO Invoice# 763573 Balance Due: 938.15 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To JUL 0 3 2018 3 F. Clesk ! ` N VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 367222 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER IU HEALTH WORKPLACE SERVICES LLC IN SUM OF$ CITY OF CARMEL 2046 RELIABLE PKWY An invoice or 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. CHICAGO, IL 60686-0020 Payee $1,001.00 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Human Resources Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 763559 43-588.00 $1,001.00 1 hereby certify that the attached invoice(s),or 6/30/18 763559 $1,001.00 1201 101 1201 101 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 Thursday,July 5,2018 Lamb, Barbara Director 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Indiana University Health Workplace Services,LLC 714 N.Senate Avenue Suite 200 121 Indianapolis, IN 46202 317-963-1535 Tax ID# 20-0994452 Invoice June 30, 2018 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Occupational UDS/June2018 1 Civic Square Carmel,IN 46032- Invoice# 763559 Service Date Description Quanti Charge Receip Ad'us Balance 06/04/2018 Regulated Drug Screen 15.00 06/05/2018 Regulated Drug Screen 1.00 22.00 22.00 Jerry Cloud XXX-XX-7945 Balance Due: 22.00 ubmitted �- JUL 01803 2018 urClr Invoice# 763559(continued)page 2 Service Date Description Quanti Charcie Recelp Adiust Balance 06/04/2018 Quick Read UDS/6panel includes 15.00 06/08/2018 Quick Read UDS/6panel 15.00 Invoice# 763559(continued)page 3 Service Date Description Quant! Charae Receipt Ad-U-sl Balance 06/13/2018 Quick Read UDS/6panel 15.00 06/11/2018 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit 06/11/2018 Confirmation for Quick Read Drug 1.00 15.00 15.00 Screen Invoice# 763559(continued)page 4 Service Date Description 15.00 06/08/2018 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit 15.00 Invoice# 763559(continued)page 5 Service Date Description Quant! Charge Recei AO-U-SI Balance 06/20/2018 Quick Read;UDS/6panel includes 1.00 15.00 15.00 kit 15.00 kit . 15.00 06/20/2018 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit Invoice# 763559(continued)page 6 Service Date Description Balance Due: 22.00 Invoice# 763559(continued)page 7 Service Date Description Quanti Charae Recei AdUs Balance 06/07/2018 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit Balance Due: 15.00 CITYCARO Invoice# 763559 Balance Due: 1001.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK