189294 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.
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Approval DOL�
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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