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334392 01/18/19 1 { *p'' CITY OF CARMEL, INDIANA VENDOR: 355031 ® ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH WfOK'AMOUNT: $*******141.00* CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 334392 M,�TON�o. CHICAGOIL 60677-7001 CHECK DATE: 01/18/19 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 545105 141.00 MEDICAL FEES _ I ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL VOUCHER NO. WARRANT NO. An invoice of bill to be properly itemized must show;kind of service,where performed,dates service rendered,by Vendor# 355031 Allowed 20 whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. Community Occupational Health Services Payee 7169 Solution Center - - Chicago, IL 60677-7001 In Sum of$ - - Purchase Order# 355031 Community Occupational Health Services Terms $ 141.00 7169 Solution Center Date Due Chicago, IL 60677-7001 ON ACCOUNT OF APPROPRIATION FOR 108-ESE Fund PO#or Invoice Description Dept# INVOICE NO. ACCT#rrITLE AMOUNT Invoice Date Number (or note attached invoice(s)or bill(s)) PO# Amount 1081-99 545105 4340700 $ 141.00 Board Members 1/3/19 545105 Pre-Employment Drug Tests xx7811 $ 141.00 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 $ 141.00 Total $ 141.00 January 9,2019 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 Cost distribution ledger classification if claim paid motor vehicle highway fund Signature 20_ Accounts Payable Coordinator Clerk-Treasurer Title Community®ccupational Healfih.:Svs 71MSo19tionM-ent(1 �s Chicago, L 60677°7001 hone 317=6210341 � � !D = FEIN: 35-1955223 JAN0, 72019 BY: Invoice J n�laly 03;, pjg Bill to: Camille Nelsen For: Carmel Clay Parks &Recreation Carmel Clay Parks &Recreation 12/18 1411 E. I I6th St. Carmel, IN 46032- Inu©ice 54510Sr Proc Code Date Description Qy Charge Receipt Adjust Balance 746404 12/18/2018 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Steven T Kudla Balance Due: 47.00 746404 12/18/2018 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Samantha N Romero Balance Due: 47.00 746404 12/18/2018 Drug Screen-Non NIDA 5 Panel 1.00 - 47.00 47.00 Scott R Wagner Balance Due:r 47.00 Invoice# 545105 glance Due: 4+!QO Please remit payment promptly