HomeMy WebLinkAbout196759 04/26/2011 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
e ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH gE�
INDIANA 46032 P 0 BOX 19383 S GK AMOUNT: $405.00
CARMEL
INDIANAPOLIS IN 46219
CHECK NUMBER: 196759
CHECK DATE: 4126/2011
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 288494 405.00 MEDICAL FEES
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
rN Phone: 317-311-6331
%-!-V FEIN: 35-1955223
APR 0 8 2011
Invoice
April 04, 2011
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 3/11
1411 E. 116th St.
Carmel, IN 46032-
Invoice 288494
Proc Code ICD9 Date Description Qty Charcle Receip Adjus Balance
Solo] 03/10/20 I Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Chatel Bennett Balance Due: 45.00
80101 03/10/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Marianne E I'larnias Balance Due: 45.00
80101 03/17/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Michele C Jones Balance Due: 45.00
80101 03/1 1/201 1 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Alexander J Milborn Balance Due: 45.00
80101 03117/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Bailey M Nish Balance Due; 45.00
80101 1)923,10 03/25/2011 Drug Screen Non NIDA 5 Panel 1,00 45.00 45.00
2) E917.9
Nikeesha Pittman Balance Due: 45.00
80101 03/08/2011 Drug Screen Non NIDA 5 Panel 1,00 45.00 45.00
Alison L Pont Balance Due: 45.00
80101 03/30/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Zachary P Rokop Balance Due; 45.00
80101 03/03/2011 Drug Screen Non N IDA 5 Panel 1.00 45.00 45.00
Margaret J Simpson Balance Due: 45.00
Purchase
Description Invoice 288494 Balance Due: 405.00
P.O. Par
Bud 1- L/-3 V REMIT PAYMENT PROMPTLY
g et Me(��ati �e IF
Line
Purchase
Approva Date_
X Invoice 288494 (continued) page 2
Cut and return with payment
Please remit 405.00 to Conununity Occupational Health Services
P.O. Box 19383
Please place invoice number 288494 on check Indianapolis, IN 46219
Phone: 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
414111 288494 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
1 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 Board Members
Dept ept INVOICE NO. A.CCT #frITLE AMOUNT
1081 -99 288494 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
21 -Apr 2011
`�j��?ZyJ2Q1`L
Signature
405.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund