HomeMy WebLinkAbout192031 11/23/2010 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $405.00
RE
s CARMEL, INDIANA 46032 P 0 BOX 19383
L o INDIANAPOLIS IN 46219 CHECK NUMBER: 192031
CHECK DATE: 11/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 277764 405.00 MEDICAL FEES
Community Occupational Health Services
Purim
Ott P.O. Box 19383
ee' Y Teyl�dianapolis, IN 46219
R Phone:
317-355-6335
Q r lo FEIN: 35- 1955223 NOV 0 8 2010
Dee--.
Invoice
November 04, 2010
Bill to: Lynn Russell For: Carmel. Clay Parks Recreations
Carmel Clay Parks Recreation 10/10
1411 E. 116th St.
Cannel, IN 46032-
Invoice 277764
Proc Code pate Description Qty Charge Receipt Adi Balance
80 101 t 0/21/2010 Drug Screen Non NIDA 5 Panel I.00 45.00 45.00
Alyssa C Agresta Balance Due: 4
S0101 10/21/2010 Drug Screen Non NIDA 5 Panel 1 00 45.00 45.00
Elizabeth G Grubbs Balance Due: 45.00
50101 10/07/2010 Drug Screen Non NIDA S Panel 1.00 45.00 45.00
Jamie M Jones Balance Due: 4 5.00
80101 10/05/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Michael D Martin Balance Due: 4 5.00
.0101 10/28/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Sally L McSpadden Balance Due: 45.00
SU 101 10/06/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45 -00
nimanuel .1 Rodriguez Balance Due: 4 5.00
solol 10/21/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Gregrey D Wetzel Balance Due: 45.00
801o1 10/19 /2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Nicole L Young Balance Due: 45.0
50101 10/20/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Yali Zhang Balance Due: 45.00
Invoice 277764(routinued)page2
lovniue# 277764BxluomDuu: 409.00
PLEASE REMIT PAYMENT PROMPTLY
c"`"na/xI"m°m`payment
Please rcmit4V5'V0m Cmnm«ni\yOccvnxbonu|Hm|rhSet-vices
P.O. Box 19383
Please place invoice number 27776400check Indianapolis, IN 46210
ybouc 317'355'6335
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
11/4110 277764 Pre employment drug testing 405.00
Total 405.00
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
405.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. 4CCT #/TITLE AMOUNT Board Members
Dept
1081 -99 277764 4340700 405.00 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
18 -Nov 2010
Signature
405.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund