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185203 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 0 4 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CFTE�ggEERR CARMEL, INDIANA 46032 P 0 BOX 19383 K AMOUNT: $1,841.00 INDIANAPOLIS IN 46219 CHECK NUMBER: 185203 CHECK DATE: 5/11/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 238290 180.00 MEDICAL FEES 1091 4340700 238290 45.00 MEDICAL FEES 1081 4340700 247412 45.00 MEDICAL FEES 1081 4340700 250964 180.00 MEDICAL FEES 1091 4340700 250964 283.00 MEDICAL FEES 1125 4340700 250964 654.00 MEDICAL FEES 1081 4340700 262114 360.00 MEDICAL FEES 1091 4340700 262114 94.00 MEDICAL FEES Community Occupational Health Services P.O. Box 19383 Indianapolis, IN 46219 Phone: 317 355 -6335 FEIN: 35- 1955223 Invoice May 05, 2009 Bill to Lynn Russell For: Carmel Clay Parks Recreation Cannel Clay Parks Recreation 4/09 1411. E. 116th St. Carmel, IN 46032 Invoice 4 238290 °ro Co Date Descrintion Qtv Charge ReceiN'. L iast Balance 80101 04/30/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 S� 45.00 Briana Loop Balance Due: 45.00 Sotol 04/22/2009 Drug Screen Non NIDA 5 Panel 1 -00 45.00 45.00 Andrew W McCormick Balance Due: 45.00 Sol 0t 04/09/2009 D r ug Screcn Non NIDA 5 Panel 1.00 45.00 45.00 Courtney E Murray Balance Due: 45.00 So l o l 04/08/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 �t,Cr 45.00 Lynn A Pont Balance Due: 4 5.00 n 80101 04/02/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Sandra J Young Balance Due: 45.00 Invoice 238290 Balance Due: 225.0 PLEASE REMIT PAYMENT PROMPTLY RATS _E P rchese Description fm Ta 0 P.O.# PorF APP 2 3 '1010 1��1 —�9— �{c��v— 1� a.L.# Budg L 5 100 CDy Line Deser D Purchaser Date BY Approval Date Cut and return with payment o er Community Occupational Health Services P.O. Box 19383 Indianapolis, IN 46219 Phone: 317- 355 -6335 FEIN: 35- 1955223 Invoice �Novembe�= 04_- 2D.09 Bill to: Lynn Russell. For: Carmel Clay Parks Recreation Cannel Clay Parks Recreation 10 -09 1411 E. 116th St. Carmel, IN 46032 Invoice 250964 Proc Code Date Description Charge Receipt Adiust Balance 10/21/2009 Rcvicw Questionnaire 1.00 10/21/2009 Respirator Fit Test 1.00 47.00 Ok 47.00 10/21/2009 Fitness To Wear Respirator Exam 1.00 72.00 72.00 Jeff Bartle Balance Due: 119.00 10/20/2009 Respirator Fit Test 1.00 47.00 47.00 10/20/2009 Review Questionnaire 1.00 OA5 10/20/2009 Fitness To Wear Respirator Exam 1.00 72.00 72.00 Andrew Burnett Balance Due: 11 50101 10/07/2009 Drug Screen -Non NIDA 5 Panel 1.00 45.00 S 45.00 Devon Gilbert Balance Due: 4 5.00 £0101 10/03/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 fVLCC_ 45.00 Fredrick L Hagemier Balance Due: 45.00 10/20/2009 Review Questionnaire 1.00 10/20/2009 Respirator Fit Test 1.00 47.00 47.00 10/20/2009 Fitness To Wear Respirator Exam 1 .00 72.00 eOj't s 72.00 91010 10/20/2009 Spirometry w/o Bronchodilator 1.00 59.00 59.00 Shawn Hart Balance Due: 178.00 10/21/2009 Review Questionnaire 1.00 10/21/2009 Respirator Fit Test 1.00 47.00 10/21/2009 Fitness To Wear Respirator Exam 1.00 72.00 72.00 Juan Mercado Balance Due: 119.00 10/21/2009 Review Questionnaire 1.00 10/21 /2009 Respirator Fit Test 1.00 47.00 47.00 10/21/2009 Fitness To Wear Respirator Exam 1.00 72.00 72.00 Invoice 250964 (continued) page 2 m Terry D Myers Balance Due: 119.00 50101 10/06/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 �5 45.00 Valerie C Peko Balance Due: 45 .00 10/20/2009 Review Questionnaire 1.00 10/20/2009 Respirator Fit Test 1.00 47.00 �jj s 47.00 10/20/2009 Fitness To Wear Respirator Exam 1.00 72.00 72.00 Craig A Smith Balance Due: 119.00 10/20/2009 Review Questionnaire 1.00 10/20/2009 Respirator Fit Test 1.00 47.00 47.00 10/20/2009 Fitness To Wear Respirator Exam 1.00 72.00 C 72.00 Michael T Snyder Balance Due: 119.00 80101 10/27/2009 Drug Screen Non N1DA 5 Panel 1.00 45.00 45.00 Leng Thao Balance Due: 45.00 G 50101 10114/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Lauren M Wright Balance Due: 45.00 Invoice 250964 Balance Due: 1117.00 PLEASE REMIT PAYMENT PROMPTLY j Purchase Description P.O.iI PorF 0.1.. N L� o� unel]escr C rr Porches Date 2 `t c D C( U)� C) 0 Aa pprovl Date 471 Cut aid return with payn3cnt Community Occupational Health Services P.O. Box 19383 Indianapolis, IN 46219 Pty Phone: 317 -355 -6335 U �g �P G FAIN: 35- 1955223 APR a 9 2010 a wag 4 u0-1 T" s u BY: Us o Invoice April 06, 2010 Bill to: Lynn Russell For: Cannel Clay Parks Recreation Carmel Clay Parks Recreation 3/10 1411 E. 116th St. Carmel, IN 46032 Invoice 262114 Proc Code Date Description Charge Receipt A" diusi Balance 80101 03/30/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 M CC- Susan Beaurain Balance Due: 45.00 80101 03/12/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Joseph F Chase Balance Due: 45.00 50101 03/30/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 David W Connors Balance Due: 45.00 80101 03/13/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Justin J Fountain Balance Due: 45.00 80101 03/13/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Brian P Lahti Balance Due: 45.00 80101 03/12/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Joshua R Meyer Balance Due: 45.00 80101 03/30/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Ericka N Mitzs Balance Due: 45.00 80t01 03/18/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Christian A Moor Balance Due: 45.00 80t01 03/30/2010 Drug Screen Non NIDA 5 Panel 1 00 45.00 45.00 Jennifer E Opdahl Balance Due: 45.00 80101 03/15/2010 E- Screen Rapid UDS 5 Panel 1.00 49.00 49.00 Invoice 262114 (continued) page 2 MCC/ James Ransford Balance Due: 49.00 Invoice 262114 Balance Due: 454.00 PLEASE REMIT PAYMENT PROMPTLY rra MAY 0 5 2010 BYo Purchase Desc "ko P.O. Q.L Bud Lute escr Purchaser Date 13OR9TZ APR 0 9 2010 BY Community Occupational Health Services P.O. Box 19383 Indianapolis, IN 46219 317 -355 -6335 Tax ID 35- 1955223 Invoice APR 2 2990 April 22, 2010 Bill to: Lynn Russe] For: Carmel Clay Parks Recreation Carmel Clay Parks Recreation 8/09 1411 E. 116th St. Carmel, IN 46032 Invoice 247412 .,ewe Scrdce Date Des Guar sty „arse Receir, ,4d;'us. 1 3 ,:,a^ce 80101 08/12/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 YF-s 45.00 Leafy Ann Dunnam SSN: 317 -98 -0732 Balance Due: 45.00 Invoice 247412 Balance Due: 45.Ou PURMM l rtptkH9 C a� V S P.O.0 Porn aE,L b R1 1- 1 M7 34b 1 O Budget Urnte Desz� 9 iiTMA 1 i oe 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 515109 238290 Pre employment drug testing 180.00 515/09 238290 Pre employment drug testing 45.00 11/4109 250964 Pre employment drug testing 180.00 11/4109 250964 Pre- employment drug testing 654.00 1114/09 250964 Pre employment drug testing 283.00 4/6110 262114 Pre employment drug testing 94.00 416/10 262114 Pre employment drug testing 360.00 4122110 247412 Pre -em to rnent drug testing 45.00 Total 1,849.00 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 1,841.00 ON ACCOUNT OF APPROPRIATION FOR 101 General 1108 ESE 1109 Monon Center PO# or INVOICE NO. CCT #RITE AMOUNT Board Members Dept 1081 -99 238290 4340700 180.00 1 hereby certify that the attached invoice(s), or 1091 238290 4340700 45.00 bill(s) is (are) true and correct and that the 1081 -99 250964 4340700 180.00 materials or services itemized thereon for 1125 250964 4340700 654.00 which charge is made were ordered and 1091 250964J 4340700 283.00 received except 1091 262114 4340700 94.00 1081 -99 262114 4340700 360.00 1081 -99 247412 4340700 45.00 5 -May 2010 Signature 1,841.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund