166165 11/24/2008 4 �qy CITY OIL CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $545.00
CARMEL, INDIANA 46032 P 0 BOX 19383
INDIANAPOLIS IN 46219 CHECK NUMBER: 166165
CHECK DATE: 11/24/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUM AMOUNT DESCRIPTION
1046 4340700 224595 473.00 MEDICAL FEES
1047 4340700 224595 43.00 MEDICAL FEES
.1201 4358800 224653 29.00 TESTING FEES
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
dwe 317- 355 -6335
1) n eo Le V�.-� Tax ID 35- 1955223
P.O. P Qf F re>° O
a.� XX �3� O Q (0 `mot 1 3,ab ?p�
end p t_E 1 y "3 o0
Une
DK Invoice
APpw November 04, 2008
Bill to: Lynn Russell For: Carmel Clay Parks &Recreation
Carmel Clay Parks Recreation 0/08
NOV j 8 2008
1411 E. 116th St.
Carmel, IN 46032-
Invoice 22445
Pr oc Code Service Date Description Q antity Charae RecgiLt Adjust Balance
80101 10/10/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Leanne Bailor Balance Due: 43.00
80101 10/31/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kelsey Blake Balance Due: 43.00
I
11 0101 10/08/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Michelle Compton Balance Due: 43.00
1
S0101 10/16/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Jessica Demaree Balance Due: 43.00
80101 10/22/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Courtney R Deming Balance Due: 43.00
SD 10/03/2008 Drug Non NIDA 5 Panel 1.00 43.00 43.00
c
Michelle Minjares Balance Due: 43.00
0-0101 10/23/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kristin N Roth Balance Due: 43.00
I
11 0101 10/24/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Richard M Shilts Balance Due: 43.00
S0101 10/22/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
is
Lauren E Sommer Balance Due: 4 3.00
50101 10/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
r
is
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Invoice 224595 (continued') page 2
Joshua N Spence Balance Due: 43.0
80101 10/01/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Angela M Starkey Balance Due: 43.00
50101 10/16/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Tabatha Towne Balance Due: 43.00
Invoice 224595 Balance Due: 516.00
PLEASE REMIT PAYMENT PROMPTLY
�.v1Y
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)) Amount
1114108 224595 Pre -emplo ment drug testing 47 3.00
1114108 224595 Pre employment drug testing 43.00
Total 516.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and 1 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
516.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 224595 4340700 473.00 1 hereby certify that the attached invoice(s), or
1047 224595 4340700_ 43.00_ 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
18 -Nov 2008
Signature
516.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
317-355-6335
Tax ID 35-1955223
Invoice
November 04, 2008
to: Shelly Lingelbaugh For: Carmel Street Dept.
Carmel Street Dept. 10/08
I Civic Square
Carmel, IN 46032-
Invoice fi 224653
Proc Code Service Date Description Quantity Charqe RtggL[g Adjust Balance
"12075
10/02/2008 Breath Alcohol Test 1.00 29.00 29,00
Travis M Tabak Balance Due: 29.00
Invoice 224653 Balance Due: 29.00
PLEASE REMIT PAYM ENT PROMPTLY
Prescribed by Slate Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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
Community Occupational Health Service Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Randoffl, Alcohol Test $29.00-
Total
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 ARRANT NO.
ALLOWED 20
Community Occupational Health Services
IN SUM OF
P.O. Box 19383
im.d.ianapolis, 11N 46219
$29.0
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1201 Human Resources
Board Members
D PT. r INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
1201 224653 5$$ QO materials or services itemized thereon for
which charge is made were ordered and
received except
20
Sig tune
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund