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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 Bud B ua �1 u -000 V3 V070o s O�F Line Ds l V3YO700 tAuo Punch 1 �l- `13`107D0 70 (,U 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