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Home My WebLink About198957 07/06/2011 *f CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CARMEL, INDIANA 46032 P 0 BOX 19383 MK AMOUNT: $1,530.00 INDIANAPOLIS IN 46219 CHECK NUMBER: 198957 CHECK DATE: 7/612011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 291730 45.00 MEDICAL FEES 1082 4340700 291730 45.00 MEDICAL FEES 1091 4340700 291730 45.00 MEDICAL FEES 1081 4340700 293412 135.00 MEDICAL FEES 1082 4340700 293412 1,215.00 MEDICAL FEES 1091 4340700 293412 45.00 MEDICAL FEES Community Occupational Health Services P.O. Box 19383 Indianapolis, IN 46219 Phone: 317 355 -6335 FEIN: 35- 1955223 0 r5a�� JQ��10 8 2011 Invoices June 02, 2011 Bill to: Lynn Russell For: Carmel Clay Parks Recreation Cannel Clay Parks Recreation 5111 1411 E. 116th St. Cannel, M 46032 Invoice 293412 Proc Code ICD9 Date Description Qty Charge Receipt Adjust Balance 31647 05/06/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 C Lauren J Bangs Balance Due: 45.00 31647 05/06/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 C.1 Samuel Bangs Balance Due: 45.00 31647 05/18/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Kelly E Barmore Balance Due: 45.00 31647 05/17/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Ryan P Duffy Balance Due: 45.00 I� 31647 05/11/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 1'�Q 45.00 X Margaret P Ellis Balance Due: 31647 05 /1 1/201 1 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Max C Ellis Balance Due: 45.00 31647 0511 1/201 I Drug Screen -Non NIDA 5 Panel 1.00 45.00 45.00 U Jill K Friedlin Balance Due: 45.00 31647 05/16/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Allison C Galloway Balance Due: 45.00 31647 05/13/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 C Steven T Goedde Balance Due: 45.00 31647 05/1 1/201 1 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 S Nancy K Goins Balance Due: 45 .00 31647 05/05/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Kristine A Grohnke Balance Due: 45. 31647 05/27/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Invoice 293412 (continued) page 2 C.J Jessica E Hofman Balance Due: 45.00 31647 05/]S/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Alyson M Johnson Balance Due: 45.00 31647 05/1 1/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Athena B Kapsalis Balance Due: 45.00 31647 05/27/201 1 Drug Screen Non NIDA 5 Panel 1.00 45.00 iI)�k 'Qj P 10 45.00 X Kyle R Killworth Balance Due f 45.00 31647 05/10/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Amy M Kiray Balance Due: 45.00 3164 05 /20/201.1 _Drug Screen Non S_Panel. __._.1,.00__ _____45..00_ Lindsay H Labas Balance Due:��r 45.00 OL 31647 05/12/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 �r� 45.00 Alexander G Lange Balance Due: 45.00 31647 05/12/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Daniel B Lange Balance Due: 45.00 31647 05/26/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Anna M Leno Balance Due: 45.00 31647 05/24/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 U Alyssa L Lucchetti Balance Due: 45.00 31647 05/25/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Lauren M McRoberts Balance Due: 45.00 31647 05/25/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Andrew P Meadows Balance Due: 45.00 316 164- 0- 5--1-1- /16 /20-- 1 1 Drug Screen -Non NIDA 5 Panel 1.00 45.00 45.00 Birgitta R Monson Balance Due: 45.00 31647 05/26/201 1 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Kyle C Montrose Balance Due: 45.00 31647 05/27/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Christian A Moor Balance Due: 45.00 31647 05/06/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Richard A Murray Balance Due: 4 31647 1) 547.2 05/17/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 2) E927.0 S Jennifer E Opdahl Balance Due: 45.00 31647 05/1 1 /_01 1 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Invoice 293412 (continued) page 3 Kimberly A Sexton Balance Due: 45.00 31647 05/14/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 UAllison M Smith Balance Due: 4 5.0 0 31647 05/18/201 1 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Catherine E Surette Balance Due: 45.00 31647 05/10/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Devyn R Tingley Balance Due: 45.00 -------------------------------------------------------I------------------------------------------------------------- 31647 05/12/2011 Drug Screen Non NIDA 5 Panel 1.00 1( 45.00 45.00 Kaitlin L Wachtel Balance Due: 45.00 3 05 05/20FI Drug Scree Non NIDA 5 Panel .00 h 4:a .00 45 Benjamin M Wertz Balance Due: 45.00 Invoice 293412 Balance Due: PLEASE REMIT PAYMENT PROMPTLY 13 gS, W ztx Purchase /fit&! d 1 e S @NJ kS J S Description I (l P.O.# PorF Budget S C pptt ksk) Line Descr Purchaser Date Approval Date C� I og(- �/3 13S__ O S,�- q V3 VO7 U U 12 /S- 06 �j /o 9/ y3yv70C) Y S -`0u Cut and return with payment .e+.r Community Occupational Health Services P.O. Box 19383 Indianapolis, IN 46219 Phone: 317- 355 -6335 FEIN: 35- 1955223 Ls Q 2011 spy I 1 'BY Invoice May 04, 2011 Bill to: Lynn Russell For: Carmel Clay Parks Recreation Cannel Clay Parks Recreation 4 -11 1411 E. 116th St. Cannel, IN 46032- Invoice 291730 I Proc Code Date Description Qiy Charge Receipt Adjust Balance 80101 04/29/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Mattliew A Bush Balance Due: 45.00 80101 04/21/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 S Whitney P Gant Balance Due: 45.00 80101 04/16/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 L David M Plough Balance Due: 45.00 Livoice 291730 Balance Due: 135.00 PLEASE REMIT PAYMENT PROMPTLY Purchase l Description P.O.# PorF Budget Line Descr_ Purchase Dat /3 Approval Date Y3 q 0 0 9 g Y3 yb 70p ob /0 bra- 99- C13YO?00 ✓ys act 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 I P.O. Box 19383 Indianapolis, IN 46219 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 6/2/11 293412 Pre-employment drug testing 135.00 6/2/11 293412 Pre-employment drug testing 1,215.00 6/2/11 293412 Pre-employment drug testing 45.00 5/4/11 291730 Pre-employment drug testing 45.00 5/4/11 291730 Pre-employment drug testing 45.00 5/4/11 291730 Pre-employment drug testing 45.00 Total 1,530.00 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 20_ Clerk- Treasurer Voucher No. Warrant No. 355031 Community Occupational Health Services Allowed 20 P.O. Box 19383 Indianapolis, IN 46219 In Sum of 1,530.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1081 -99 293412 4340700 135.00 1 hereby certify that the attached invoice(s), or 1082 -99 293412 4340700 1,215.00 bill(s) is (are) true and correct and that the 1091 293412 4340700 45.00 materials or services itemized thereon for 1091 291730 4340700 45.00 which charge is made were ordered and 1081 -99 291730 4340700 45.00 received except 1082 -99 291730 4340700 45.00 28 -Jun 2011 Signature 1,530.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund