185696 05/26/2010 CITY OF CARMEL INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH ggE��[
CARMEL, INDIANA 46032 P O BOX 19383
GCK AMOUNT: $537.00
INDIANAPOLIS IN 46219 CHECK NUMBER: 185696
CHECK DATE: 5/26/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 050510 222.00 OTHER EXPENSES
1081 4340700 264049 45.00 MEDICAL FEES
1082 4340700 264049 270.00 MEDICAL FEES
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
Phone: 317- 355 -6335
FEIN: 35- 1955223
O T9 U?.Yna T
NA
Invoice
BY:..
May 05, 2010
Rill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 4/10
1411 E. 116th St.
Carmel, IN 46032
Invoice 264049
Prot Code Date Description Qty Charge Receipt i di Balance
80101 04/29/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Patrick C Burtch Balance Due: 45.00
80101 04/29/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Rohan K Dharan Balance Due: 45.00
801 01 04/12/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Melissa L Gordon Balance Due: 45.00
80101 04/14/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Kayree J Horn Balance Due: 45.00
801 01 04/28/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Andrew W McCormick Balance Due: 45.00
80101 04/28/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Monica E Segar Balance Due: 45.00
80101 04/07/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Stacey Zimmerman Balance Due: 45.00
Purchase
Description
P.O. P Pulp Invoice 264049 Balance Due:
3
a.L 0
Budget PLEASE REMIT PAYMENT PROMPTLY
Line Descr
Purchaser Date
Approval Date
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
515110 264049 Pre employment drug testing 45.00
515110 264049 Pre-employment drug testing 270.00
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 i
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
1081 -99 264049 4340700 45.00 1 hereby certify that the attached invoice(s), or
264049 4340700 270.00 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
20 -May 2010
Signature
315.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
Phone: 317- 355 -6335
FEIN: 35- 1955223
Invoice
May 05, 2010
Bill to: Shelly Lingelbaugh For: Carmel Utilities
Carmel Utilities 4/10
1 Civic Square
Carmel, IN 46032
I nvoic e 263475
r� rti..._ Desc ription n a �j
Proc -Code ud Description w Char l;`cC @iqt rid LOlal iC
04/29/2010 Whisper Test 1.00 7.00 7.00
81002 04/29/2010 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00
99173 04129/2010 Snellen 1.00 7.00 7.00
99386 04/29/2010 DOT /PPCL Exam 1.00 53.00 53.00
Jeffery Cooper XXX -XX -7615 Balance Due: 74.00
04/01/2010 Whisper Test 1.00 7.00 7.00
81002 04/01/2010 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00
99173 04/01/2010 Snellen 1.00 7.00 7.00
99386 04/01/2010 DOT /PPCL Exam 1.00 53.00 53.00
Eric S Robinson XXX -XX -7938 Balance Due: 74.00
04/01/2010 Whisper Test 1.00 7.00 7.00
81002 04/01/2010 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00
99173 04/01/2010 Snellen 1.00 7.00 7.00
99386 04101/2010 DOT /PPCL Exam 1.00 53.00 53.00
Dennis M Russ XXX -XX -4592 Balance Due: 74.00
Invoice 263475 Balance Due: 222.00
PLEASE REMIT PAYMENT PROMPTLY
n
M' LOt
7
VOUCHER 105422 fNARRANT ALLOWED
355031 IN SUM OF
COMMUNITY OCCUPATIONAL HEALTI
PO BOX 19383
INDIANAPOLIS, IN 46219
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
050510 01- 7042 -06 $222.00
Voucher Total $222.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
355031
COMMUNITY OCCUPATIONAL HEALTH Purchase Order No.
PO BOX 19383 Terms
INDIANAPOLIS, IN 46219 Due Date 5/1312010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/13/2010 050510 $222.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have audited same in accordance w with IC 5- 11- 10 -1.6
Date Officer