190234 09/29/2010 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
0 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH Uk& AMOUNT: $495.00
CARMEL, INDIANA 46032 P 0 BOX 19383
INDIANAPOLIS IN 46219 CHECK NUMBER: 190234
CHECK DATE: 9/29/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 272852 495.00 MEDICAL FEES
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
Phone: 317- 355 -6335
FEIN: 35- 1955223
SEP 7 2010
157 Invoice
September 03, 2010
Bill to: Lynn Russell For: Cannel Clay Parks Recreation
Cannel Clay Parks Recreation 8/10
1411 E. 1 I6th St.
Carmel, IN 46032-
Invoice 272852
Proc Code Date Description Qty Charpe Re_ ceip Adjust Balance
SOE01 08/06 /2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Sarah E Alley Balance Due: 45.00
80t01 08/09/2010 Drug Screen Non NIDA 5 Panel t.00 45.00 45.00
Gabrielle E Bowers Balance Due: 45.00
5010] 08 /09/2010 Dru g Screen Non NIDA 5 Panel 1.00 45.00 45.0 0
Yolanda M Edmonds Balance Due: 45.00
80101 08/11/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Trina L Floyd Balance Due: 45.00
80101 08/05/20t0 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Sarah E Gasper Balance Due: 45.00
80101 08/05/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Kandace R Jones Balance Due: 45.00
SOIOt 08/04/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Shamepane R Martin Balance Due: 4 5.00
80101 08/11/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Katina Prekas Balance Due: 45.00
80101 08/19/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
David S Sandberg Balance Due: 45.00
50101 08/11/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Leslie K Wimberly Balance Due: 45.00
50101 08/27/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Lauren A Woeste Balance Due: 45.00
Invoice 272852 (continued) page 2
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Invoice %7%05% Balance Due: 495.00
PLEASE REMIT PAYMENT PROMPTLY
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
R0. Box 19383
Indianapolis, IN 46219
Invoice Invoice Description
Date Number (or note attached invoice (s) or bill(s)) PO Amount
9/3110 272852 Pre employment drug testing 495.00
Total 495.00
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
495.00
ON ACCOUNT OF APPROPRIATION FOR
101 General/108- ESE/109 Monon Center
PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members
Dept
1081 -99 272852 4340700 495.00 1 hereby certify that the attached invoice(s), or
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
23 -Sep 2010
Signature
495.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicEe highway fund