191162 10/27/2010 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH ggi�
CARMEL, INDIANA 46032 P 0 BOX 19383 CFfEGK AMOUNT: $724.00
INDIANAPOLIS IN 46219
CHECK NUMBER: 191162
CHECK DATE: 10/27/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMO UNT DESCRIPTION
1081 4340700 275266 634.00 MEDICAL FEES
1091 4340700 275266 90.00 MEDICAL FEES
Community Occupational Health Services
P.O. Box 19383fiasA
Indianapolis, IN 46219
DescrtptiM
Phone: 317 -355 -6335 P.O.8 Ptah
Q FEIN: 35- 1955223 Ltd
OCT 20 v�
Purim -/to
-By Invoice j091 90.
October 05, 2010 t0W- q 9 -y3 y 0 ?ov J� &_3y vv
Bill to: Lynn Russell For: Camel Clay Parks Recreation
Carmel Clay Parks Recreation 9/10
1411 E. 116th St.
Carmel, IN 46032-
Invoice 275266
Proc Code ICD9 Date Description Qtv Charge Receipt Adiust Balance
50101 09/22/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Lenisha Conners Balance Due: 4 5.00
f
50101 09/14/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Ethan J Cox Balance Due: 41.00
511101 09/15/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
John Gil Balance Due: 45.
50101 09/15/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Amanda N Gillim Balance Due: 45.00
50101 09/30 /2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Bradley W Holsten Balance Due: 45.00
50101 1) 493.90 09/30/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
2) 756.09
Carrie Keavney Balance Due: 4 5;00
Sol0t 09/21/2010 E- Screen Rapid UDS 5 Panel 1.00 49.00 49.00
Brooke Kempher Balance Due: 4
S0101 09/14/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
David E Lammers Balance Due: 4 5.00
50101 09/16/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Josh 1-1 Levine Balance Due: 45.00
S0101 09/29/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Julia L Newten Balance Due: 45.00
50101 09/14/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jessica L Rowls Balance Due: 45.00
50101 09/09/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Invoice 275266 (continued) page 2
Jessica M Schroeder Balance Due: 4
S0101 09/01 /2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Monique M Smith Balance Due: 4
S0101 09 /28/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Amanda Spencer Balance Due: 45.00
S0101 09/23/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Natalie E Strunk Balance Due: 45.00
80101 09/23/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Chelsea Wheatley Balance Due: 45.00
l 10 w it
OCT Q 8 2010
BY:
Invoice 275266 Balance Due: 724.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and retw7t 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
10/5110 275266 Pre employment drug testing 634.00
1015110 275266 Pre employment drug testing
90.00 mom
Total 724.00
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
724.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE 109 Monon Center
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1081 -99 275266 4340700 634.00 1 hereby certify that the attached invoice(s), or
1091 275266 4340700 90.00 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
21 -Oct 2010
Signature
724.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund