HomeMy WebLinkAbout194144 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CHECK AMOUNT: $435.00
CARMEL, INDIANA 46032 P 0 BOX 19383
INDIANAPOLIS IN 46219 CHECK NUMBER: 194144
CHECK DATE: 2/3/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 281829 270.00 MEDICAL FEES
1091 4340700 281829 90.00 MEDICAL FEES
1125 4340700 281829 75.00 MEDICAL FEES
Community Occupational Health Services
A es P.O. Box 19383
Purchase Indianapolis, IN 46219
p#fon Phone: 317 -355 -6335
P.O FEIN: 35- 1955223 .O PorF AN O 7 2011
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Approval pate Invoice
January 05, 2011
Bill to: Lynn Russell For: Cannel Clay Parks Recreation
Cannel Clay Parks Recreation 12/10
1.411 E. 1 16th St.
Cannel, IN 46032-
Invoice 281829
Proc Code Date Description Q�tv Charge Receipt Adiust Balance
80101 12/17/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
82075 12/17/2010 Alcohol, Breath 1.00 30.00 30.00
Andrew W Burnett Balance Due: 75.00
80101 12/21/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Antaiwan L Donigan Balance Due: 45.00
80101 12/22/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Cameron. E Johnson Balance Due: 45.00
80101 12/15/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Roger G Johnson Balance Due: 45.00
80101 12/23/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Melissa R Lahti Balance Due: 45.00
80101 12/01/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Sherri L Lang Balance Due: 4 5.0 0
80101 12/03/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Michael J Normand Balance Due: 45.00
80101 12/16/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Kayla D Rutley Balance Due: 4 5.04
80101 12/03/2010 Drug Screen Non NIDA 5 Pancl 1.00 45.00 45.00
Bruce X1 Taflinger Balance Due: 45.00
Invoice 281829 (continued) page 2
JAN 0 7 2011
L4 P
Purchise
C-c scription
P.O. P or F
G.L.
Budget
Line Descr
Purchaser Date
Approval Date
Invoice 281829 Balance Due: 435.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and return 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
1/5/11 281829 Pre employment drug testing 75.00
1/5/11 281829 Pre- employment drug testing 90.00
1/5/11 281829 Pre employment drug testing 270.00..
Total 435.00
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and 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
435.00
ON ACCOUNT OF APPROPRIATION FOR
101 General 1 108 ESE 1 109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 281829 4340700 75.00 1 hereby certify that the attached invoice(s), or
1091 281829 4340700 90.00 bill(s) is (are) true and correct and that the
1081 -99 281829 4340700 270.00 materials or services itemized thereon for
which charge is made were ordered and
received except
27 -Jan 2011
Signature
435.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund