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Home My WebLink About189294 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1. of 1 0 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH M& AMOUNT: $1,590.00 CARMEL, INDIANA 46032 P O BOX 19383 INDIANAPOLIS IN 46219 CHECK NUMBER: 189294 CHECK DATE: 8/31/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1082 4340700 267995 330.00 MEDICAL FEES 1091 4340700 267995 180.00 MEDICAL FEES 1081 4340700 270552 720.00 MEDICAL FEES 1082 4340700 270552 135.00 MEDICAL FEES 1091 4340700 270552 135.00 MEDICAL FEES 1125 4340700 270552 90.00 MEDICAL FEES Community Occupational Health Services Purchase P.O. Box 19383 Description �Mf 'OO'J A 'eS (/�L�1 7-4 Indianapolis, IN 46219 P.O. PorF Phone: 317 355 -6335 FEIN: 35- 1955223 V T 7 E rn G.L. id et Q� (OW? TP S1-s) R Ze escr 9 20 10 1'archaser Qet9 Approval DOL� �3�� 0 Invoice 1@7: iv?� -q9 ��3 yo 7vv a. Y -�00 -1 ov Y3 yU 7u U F0 July o 6, 2010 Bill to: Lynn Russell For: Carmel Clay Parks Recreation Carrnel Clay Parks Recreation 6/10 141.1 E. t 16th St. Carmel, IN 46032 LL. Invoice 267995 Proc Code Date Description QQt V Ch arge Re ceipt Adjust Balance 50101 06/24/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Titus E Austin Balance Due: 4 5.00 S01O1 06/23/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 .Richard G Berry Balance Due: 45.00 80101 06/25/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Jordan Brumbeloe Balance Due: 45.00 50101 06/26/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Jacob T Daniel Balance Due: 45.00 S0 t01 06/24/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Nicholas Green Balance Due: �ti 45.00 I 50101 06/25/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Anna NI Leno Balance Due: 45.00 50101 06/23/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Brandon D Neumann Balance :Due: 4 4 5.00 82075 06/09/2010 Breath Alcohol Test 1.00 30.00 30.00 Brady N O'Cull Balance Due: 30. 00 50101 06/24 /2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 /1 45.00 Matthew A Pearson Balance Due: [4f 45.00 82075 06/09/20 t0 Breath Alcohol Test 1.00 30.00 30.00 Brenton C Robinson Balance Due: 30.00 50101 06/02/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Kelsey N Schulz Balance Due: 45.00 80101 06/02/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Invoice 267995 continued page 2 Demetria M Todd Balance Due: 45.00 Invoice 267995 Balance Due: 510.00 PLEASE REMIT PAYMENT PROMPTLY Cut and return with payment Purohas� Community Occupational Health Services ascription -e� Lie 9 TeS tS) P.O. Box IN 19 46 Indianapolis, IN 46219 P.O. P0rF Phone: 317 -355- 6335q 77 Tr 7Y FEIN: 35- 1955223 ,g Descr� �1 vchase DoW. py 0Y/_ 9 V-3 V07 0 0 �.vo Invoice y3`10700 1 13 y0 7UU /35. oo August 04, 2010 a5= Y1 e -0OD- V3yo 700 1 70,40 Bill to: Lynn Russell For: Carmel Clay Parks Recreation Carrel Clay Parks Recreation 7/10 1411 E. 116th St. Carmel, IN 46032- Invoice 270552 Proc Code Date Description Qty Charge Receipt Adjust Balance 80101 07/15/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Cody D Ballard Balance Due: 45.00 80101 07/08/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 1 45.00 Tracey A Bloomfield Balance Due: 45.00 80101 07/08/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Jessica E Bowman Balance Due: 45.00 80101 07/16/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Shandi N Bray Balance Due: 45.00 80101 07/05/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Thomas D Cimino Balance Due: 45.00 80101 07/05/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Kelsey A Diebert Balance Due: 45.00 80101 07/06/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Jessica S Evans Balance Due: L] 45.00 80101 07/15/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 Z 45.00 Erik M Felts Balance Due: 45.00 80101 07/15/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Taryn M Ford Balance Due: 4 5.0 0 80101 07/30/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Emily A Gettinger Balance Due: 45.00 80101 07/06/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Matthew A Gregory Balance Due: 45.00 80101 07/28/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Invoice 270552 continued page 2 Bernadette L Grove Balance Due: 45.00 80101 07/16 /2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Richard C Gunyon Balance Due: �1 45.00 80101 07/15/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Jeffrey D Hooton Balance Due: 45.00 80t01 07/22/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Joshua J Jones Balance Due: 45.00 8010 i 07/15/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Jordan T Mentz Balance Due: 45.00 "00101 07/01/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Jessica C Miller Balance Due: 45.00 80101 07/10/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Joshua R O'Brien Balance Due: 45.00 80101 07/01/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 C 45.00 Brittany E Poe Balance Due: 45.00 80101 07/30/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Vicki R Rubio Balance Due: C J� 45.00 -1 80101 07/28/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Latia R Russell Balance Due: 45.00 80101 07/28/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Megan E Shaffer Balance Due: 45.00 80101 07/19/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 a^� 45.00 Michael T Snvder Balance Due: 45.00 80101 07/08/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 f 45.00 Cynthia D Washington Balance Due: t`! 45.00 Invoice 270552 Balance Due: 1080.00 PLEASE REMIT PAYMENT PROMPTLY C'ul and return with navment 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 716110 267995 Pre employment drug testing 180.00 0.00 18 7/6110 267995 Pre- employment drug testing 720.00 .00 8/4/10 270552 Pre employment drug testing 135.00 8/4/10 270552 Pre employment drug testing 135 m .00 814110 270552 Pre employment drug testing 814110 270552 Pre eployment drug testing 90 Total 1,590.00 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and 1 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 1,590.00 ON ACCOUNT OF APPROPRIATION FOR 101 General/108- ESEI109 Monon Center PO# or INVOICE N0. ACCT #fTITLE AMOUNT Board Members Dept 1082 -99 267995 4340700 330.00 1 hereby certify that the attached invoice(s), or 1091 267995 4340700 180.00 bill(s) is (are) true and correct and that the 1081 -99 270552 4340700 720.00 materials or services itemized thereon for 109,1 270552 4340700 135.00 which charge is made were ordered and 1082 -99 270552 4340700 135.00 received except 1125 270552 4340700 90.00 26 -Aug 2010 Signature 1,590.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund