HomeMy WebLinkAbout181860 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
0 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH SE
RV
j �K AMOUNT: $45.00
,1 CARMEL, INDIANA 46032 P 0 BOX 19383 CF
'M ow .o INDIANAPOLIS iN 46219 CHECK NUMBER: 181860
CHECK DATE: 2/3(2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 256495 45.00 MEDICAL FEES
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219 Purchase
Phone: 317- 355 -6335 Description j �la�C� I-rc Cs ((►t9 Ts(s)
FEIN: 35- 1955223 p•Qf Pes ig
?oo 3Vo7U0 ‘131-11:1:1
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Invoice Ate,. DatILIMMIMIM
January 05, 2010
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 12/09
1411 E. 116th St.
Carmel, IN 46032-
Invoice 256495
Froc Code Date Description Qty Charne Receipt Adjust Balance
80101 12/22/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Michael J Myers Balance Due: 45,Q4
Invoice 256495 Balance Due: 45.00
EFFECTIVE 01/01 /2010 SOME PORTIONS OF OUR FEE SCHEDULE HAVE
INCREASED. If YOU HAVE ANY QUESTIONS PLEASE CONTACT YOUR.
ACCOUNT MANAGER. THANK YOU
Cut and return with payment
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
P.O. Box 19383
Indianapolis, IN 46219
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/5/10 256495 Pre- employment drug testing 45.00
Total 45.00
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
Clerk- Treasurer
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
P.O. Box 19383
Indianapolis, IN 46219
In Sum of
45.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO# or Board Members
INVOICE NO. ACCT #JTITLE AMOUNT
Dept
1081 -99 256495 4340700 45.00 I 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
28 -Jan 2010
4110 Pi—
Signature
45.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund