195875 03/29/2011 ^"c• CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH M& AMOUNT: $360.00
t? CARMEL, INDIANA 46032 P 0 BOX 19383
INDIANAPOLIS IN 46219 CHECK NUMBER: 195875
CHECK DATE: 3/29/2011
DEPARTMENT ACCOUNT P NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 286248 360.00 MEDICAL FEES
Community Occupational Health Services
P.O. Box 19383
Purchase f Indianapolis, IN 46219
Description lGfQt S 9 'S Phone: 317- 355 -6335
P.O. P or F FEIN: 35- 1955223
G.L.# 1081 99- y3 y07_ 00 D Tg ON W 31
Budget -ot.g rs 15
Line Descr MAR p o 7 2011
Purchaser Date 3 �f Cr 1
Approval Date Invoice
March 03, 2011
Bill to: Lynn Russell For: Cannel Clay Parks Recreation
Cannel Clay Parks Recreation 2/ 1 1
1411 E. 1 16th St.
Cannel, IN 46032-
Invoice 286248
Proc Code Date Description Qty Charge Receipt Adiust Balance
80101 02/10/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Monica Awad Balance Due: 45.00
80101 02/09/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Msaike Z Badawi Balance Due: 4 5. 00
80101 02/10/2011 Drug Screen Non NIDA 5 Panel 1.00 .45.00 45.00
John D Brake Balance Due: 45.00
80101 02/10/2011 Drug Screen Non N I DA 5 Panel 1.00 45.00 45.00
Andrea B Czarnik Balance Due: 45.00
80101 02/10/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Endia N Scanlan Balance Due: 45.
80101 02/23/20t l Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Emily L Smith Balance Due: 45.00
80101 02/23/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Danielle M Vercesi Balance Due: 45.00
80101 02/17/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Lyndsay M Zimmerman Balance Due: 45.00
Invoice 286248 Balance Due: 360.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and return with U aymcnt
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
313111 286248 Pre-employment drug testing 360.00
Total 360.00
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- 16 -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$
360.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -99 286248 4340700 360.00 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
24 -Mar 2011
�L M
Signature
360.00; Accounts Payable Coordinator
Cost distribution ledger classification if i Title
claim paid motor vehicle highway fund
i