184233 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $1315.00
CARMEL, INDIANA 46032 P O BOX 19383
INDIANAPOLIS IN 46219 CHECK NUMBER: 184233
CHECK DATE: 4/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 258942 270.00 MEDICAL FEES
1125 4340700 258942 45.00 MEDICAL FEES
I
Community Occupational Health Services
P.O. Box 19383
Purdew Indianapolis, IN 46219
�L 5 ;;zspfs Phone: 317 -355 -6335
P.O 0 PwF FEIN: 35- 1955223
�3 X0700
i e l P s� S- 0 V3VG 700
u s �o
e,. Invoice S
March 03, 2010
Bill to: Lynn Russell For: Carmel Clay Parks
Carmel Clay Parks Recreation 2 -10
1411 E. 116th St. A� 0 6' 2010
Carmel, IN 46032-
Invoice 4 258942
��Y:...
-roc Code Date Description Charge Receipt r� dius Balance
50101 02/01/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Leslie A Baker Balance Due: 45.00
80101 02/25/2010 Drug Screen Non NIDA 5 Panel 1_00 45.00 45.00
Bailey A Cook Balance Due: 45.00
80 f 01 02/26/2010 Drug Screen Non N IDA 5 Panel 1.00 45.00 45.00
Christina W Donnelly Balance Due: 45.00
80101 02/03 /2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 SSE 45.00
Lindsay M Eckert Balance Due: 45.00
80101 02/24/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 C 45.00
Kenneth 12 Nlosley Balance Due: 45.00
80101 02/25/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 5 45.00
t
Andrew Servais Balance Due: 45.00
80101 02/23/2010 Drug Screen -Non NIDA 5 Pane] 1.00 45.00 P/N er t I 45.00
Craig A Smith Balance Due: 4
Invoice 258942 Balance Due: 315.00
EFFECTIVE 01 /01 /2010 SOME PORTIONS OF OUR FEE SCHEDULE HAVE
INCREASED. IF YOU HAVE ANY QUESTIONS PLEASE CONTACT YOUR
ACCOUNT MANAGER. THANK YOU
(7m and rehern with' navment
I
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
313110 258942 Pre employment drug testing 270.00
313110 1258942 Pre employment drug testing 45.00
Total 315.00
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
315.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE 101 General Fund
PO# or INVOICE NO. ACCT #rrITLE AMOUNT Board Members
Dept
1081 -99 258942 4340700 270.00 1 hereby certify that the attached invoice(s), or
1125 258942 4340700 45.00 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
8 -Apr 2010
Signature
315.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund