HomeMy WebLinkAbout195001 03/02/2011 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH
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CARMEL, INDIANA 46032 P 0 BOX 19383 CFfECK AMOUNT: $761.00
INDIANAPOLIS IN 46219 CHECK NUMBER: 195001
CHECK DATE: 312/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 280090 270.00 MEDICAL FEES
1091 4340700 280090 356.00 MEDICAL FEES
1081 4340700 283917 90.00 MEDICAL FEES
1091 4340700 283917 45.00 MEDICAL FEES
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
Purchase h/� Q r Phone: 317- 355 -6335 D
Description 6 V t i CA e FEIN. 35- 1955223
P.O. P orF DEC S 7 2010
G.L 9 Y3 yo 70 0 a 70, oC
u e %tea s y 3 V O '70 0 Yo
Purchaser Date
Invoice
�p Date December 03, 2010
Bill to: Lynn Russell For: Canrtel Clay Parks Recreation
Carmel Clay Parrs Recreation 11/10
1411 E. 116th St.
Carmel, IN 46032
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Invoice 280090
Proc Code ICD9 Date Description QtY Charge Receipt Adiust Balance
80101 1) 924.3 11/12/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
2) E916
Cynthia M Canada Balance Due: 45.00
80101 11/24/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Lenisha Conners Balance Due: 45.00
80101 11/10/2010 Drug Screen Non NIDA 5 Pancl 1.00 45.00 45.00
Lauren B Harness Balance Due: 45.00
11 /02 /2010 Review Questionnaire 1.00
1 1/02/2010 Respirator Fit Test 1.00 47.00 47.00
11/02/2010 Fitness To Wear Respirator Exam 1.00 72.00 72.00
94010 l 1/02/2010 Spirometry w/o Bronchodilator 1.00 59.00 59.00
Carrie E Keavney Balance Due: 178.00
11/02/2010 Review Questionnaire 1.00
1 1/02/2010 Respirator Fit Test 1.00 47.00 47.00
11/02/2010 Fitness To Wcar Respirator Exam 1.00 72.00 72.00
94010 11/02/2010 Spirometry w/o Bronchodilator 1.00 59.00 59.00
Eric R Mehl Balance Due: 1 78.00
80101 11/03/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Sarah E Reed Balance Due: 4 5.00
80101 1 1/1 1/2010 Drug Screen Non NIDA 5 Pancl 1.00 45.00 45.00
Donna S Williams Balance Due: 45.0
80101 11/21/2010 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
John B Wright Balance Due: 45.00
Invoice 250090( continue
d) page 2
Invoice 280090 Balance Due: 626.00
PLEASE REMIT PAYMENT PROMPTLY
Cut -ai d retu�7 with vi eent
Community Occupational Health Services
P.O. Box 19383
Purchase �nll Indianapolis, IN 46219
Description P er Phone: 317- 355 -6335
P.O. FEIN: 35- 1955223
G.L# °�1 -99— Y3D7D0 VD D m
Budget 3 V 0 `7 00 X5.00
bane escr FEB 10 201
Purchase 2
Approval Date In voice
February 09, 2011
Bill to: Lynn Russell For: Cannel Clay Parks Recreation
Carmel Clay Parks Recreation
1411 E. 1 16th St.
Carmel, IN 46032-
lnvoice 283917
Proc Code Date Description QtV Charge Receipt Adjust Balance
50101 01/05/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Heather R Ford Balance Due: 4 5.00
50101 01/27/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Tiffany D Jennings Balance Due: 45.00
80101 01/20/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jonathan E Prather Balance Due: 45.00
Invoice 283917 Balance Duc: 135.00
PLEASE REMIT PAYMENT PROMPTLY
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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
or note attached invoice(s) or bill(s)) PO Amount
Date Number g 270.00
1213110 280090 Pre employment drug testing 356.00
1213110 280090 Pre employment drug testing 90.00
2/9111 283917 Pre employment drug testing 45.00
219111 283917 Pre employment drug testing
Total 761.00
i 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
761.00
ON ACCOUNT OF APPROPRIATION FOR
'108 ESE 1 109 Monon Center
PO# or INVOICE NO. CCT #rrITLE AMOUNT Board Members
Dept
1081 -99 280090 4340700 270.00 1 hereby certify that the attached invoice(s), or
1091 280090 4340700 356.00 bill(s) is (are) true and correct and that the
1081 -99 283917 4340700 90.00 materials or services itemized thereon for
1091 283917 4340700 45.00 which charge is made were ordered and
received except
24 -Feb 2011
Signature
761.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund