182801 03/03/2010 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
tI ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH EWK AMOUNT: $164.00
CARMEL, INDIANA 46032 P O BOX 19383
a o zo INDIANAPOLIS IN 46219 CHECK NUMBER: 182801
CHECK DATE: 3/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 257144 45.00 MEDICAL FEES
1091 4340700 257144 119.00 MEDICAL FEES
Community Occupational Health Services
Purchase P.O. Box 19383
Desadptiorl a-< Indianapolis, IN 46219
P.O. PorIF Phone: 317- 355 -6335
FEIN: 35- 1955223
Bud
Line Dest r _.t�/4 n, P AA F S
Putcha Date z 2 e, o 3 D "7 U U 4 0
ApRm Date' io, v Invoice $w'
February 03, 2010
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 01/10
1411 E. 116th St.
Carmel, IN 46032-
Invoice 257144
c, Ch ry0 pc eipl A Ra n c
01/06/2010 Fitness To Wear Respirator Exam 1.00 72.00 72.00
01/06/2010 Respirator Fit Test 1.00 47.00 47.00
William H Loveall Balance Due: 119.00
S0101 01/04/2010 Drug Screen Non NIDA 5 Panel 1.00 45 -00 45.00
Kristel A Tippins Balance Due: 45.00
Invoice 257144 Balance Due: 164.00
EFFECTIVE 01101/2010 SOME PORTIONS OF OUR FEE SCHEDULE HAVE
INCREASED. 1F YOU HAVE ANY QUESTIONS PLEASE CONTACT YOUR
ACCOUNT MANAGER. THANK YOU
Cut and re €urn with payment
Please remit 164.00 to Conununity Occupational Health Services
Please place invoice number 257144 on check P.O. Box 19383
Indianapolis, IN 46219
Phone: 317 355 -6335
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
2/3/10 257144 Pre employment drug testing 45.00
2/3/10 257144 Pre-employment drug testing 119.00
Total 164.00
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
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
P.O. Box 19383
Indianapolis, IN 46219
In Sum of
164.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE 109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -99 257144 4340700 45.00 1 hereby certify that the attached invoice(s), or
1091 257144 4340700 119.00 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
r 25 -Feb 2010
Signature
164.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund