188287 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH
CARMEL, INDIANA 46032 P o BOX 19383 MK AMOUNT: $585.00
INDIANAPOLIS IN 46219 CHECK NUMBER: 188287
CHECK DATE: 8/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 265758 45.00 MEDICAL FEES
1082 4340700 265758 540.00 MEDICAL FEES
j, Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
Phone: 317-355-6335
FEIN: 35-1955223
FIF
Invoice
June 04, 2010
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Cannel Clay Parks Recreation 5110
1411 E. I I 6th St.
Carmel, IN 46032-
Invoice 265758
Proc Code Date Description Qty Charge Receip Aluat Balance
80101 05/05/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jessica Ballinger Balance Due: 45.00
80101 05/06/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Abigail L Benjamin Balance Due: 45.00
I
80101 05/04/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Brandon P Brown Balance Due: 45.00
80101 05/13/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jessica E Hofman Balance Due: 45.00
80101 05/07/2010 Drug Screen -Non NIDA 5 Panel 1-00 45.00 45.00
Joseph J Kartholl Balance Due- 45.00
80101 05/11/2010 Drug Screen Non NIDA 5 Panel 1,00 45.00 45.00
Amy M Kiray Balance Due: 45.00
80101 05/28/2010 Drug Screen Non NIDA 5 Panel 1.00 45-00 45.00
Allyssa L Lucchetti Balance Due: 45.00
1
80101 05/19/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Birgitta R Monson Balance Due: 45.00
80101 05/19/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Dustin S 0 Bold Balance Due: 45.00
80101 05/12/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
6,q
Invoice 265758 (continued) page 2
Brady O'Cull Balance Due: 45.00
8010 I 05/12/2010 Drug Screen -N o n NIDA 5 Panel 1.00 45.00
Lauren M Reising Balance Due: 45.00
got 01 05/1 4/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Carmen A Saucedo Balance Due: 45.00 1.
80101 05/07/2010 Drug Screen No NIDA 5 Panel 1.00 45.00 4
Nathaniel T Woeste Balance Due: 45.00
Invoice 265758 Balance Due: 585.00
PLEASE REMIT PAYMENT PROMPTLY
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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
614110 265758 Pre employment drug testing 45.00
614110 265758 Pre employment drug testing 540.00
Total 585.00
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
585.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO #or INVOICE NO. ACCT #MTL AMOUNT Board Members
Dept
1081 -99 265758 4340700 45.00 1 hereby certify that the attached invoice(s), or
1082 -99 265758 4340700 540.00 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
29 -Jul 2010
Signature
585.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund