165184 10/29/2008 e- C" OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVEC SQUARE COMMUNITY OCCUPATIONAL HEALTH SS�EgR�[
CARMEL, INDIANA 46032 P o Box 19383 CHEK AMOUNT: $1,376.00
"oa INDIANAPOLIS IN 45219
CHECK NUMBER: 165184
CHECK DATE: 10/2912008
:DEPARTMENT ACCOUNT PO N UMBER INVOICE NUMBER AMOUNT DESCRIPTION
,1125 4340700 222368 1,376.00 MEDICAL FEES
�J.
Invoice 222368 (continued) page 3
OCT o 6' Rebecca Schmiesing Balance Due: 43.00
;0101 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Andrea N Seif Balance Due: 43.00
30101 09/19/2008 Drug Screen Non NTDA 5 Panel 1.00 43.00 43.00
Patricia A Sigh Balance Due: 43.00
>0101 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Craig A Smith Balance Due: 43.00
;11101 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Michael T Snyder Balance Due: 43.00
51101 09/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
;oshua M Taylor. Balance Due: 43.00
r 0101 09/26/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Taryan N Temple Balance Due: 43.00
o101 09/04/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Denience P Witt Balance Due: 43.00
Invoice 222368 Balance Due: 1376.00
PLEASE REMIT PAYMENT PROMPTLY
.4 Get and rr.lurn with navtnenl
Community Occupational Health Services
P.O. Box 19383
u, chase Indianapolis, IN 46219
Description
P or F 317 -355 -6335
P.O. Tax ID 35- 1955223
G.L.
Budget
Line Descr
Purchaser
Approval r_]atw N
Invoice
`H 3-7 k np October 02, 2008
Pill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 9/08
1411 E. 116th St.
Carmel, IN 46032
Invoice 222368
foc Clue Service Date D escripiion Quantity Cnarge Re_ ceipt Adiust Balance
50101 09/22/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
L John R Aleksa Balance Due: 43.00
80101 09/26/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Jason Anderson Balance Due: 43.00
S0101 09/24/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 4100
Lauren J Bangs Balance Due: 43.00
1;0101 09/26/2008 Drug Screen -Non NIDA 5 Panel 1.00 43.00 43.00
Brian Basey Balance Due: 43.00
0101 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Meredith L Bentley Balance Due: 43.00
0101 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Autumn Bragg Balance Due: 43.00
«v,0,
091/26/2 000 Drag Screen Nun NIDA 5 Panel 1.00 43.00 43.00
George H Bretzlaff Balance Due: 43.00
S0101 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 4100 43.00
Andrew W Burnett Balance Due: 43.00
;'.0101 09/25/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Ryan Duffy Balance Due: 43.00
80101 09/06/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
l:
Invoice 222368 (continued) page 2
Sandra M Guirguis Balance Due: 43.00
301 1 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Ryan P Hart Balance Due: 43.00
30101 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Shawn M Hart Balance Due: 43.00
80101 09/10/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Christie L Hoffman Balance Due: 43.00
80101 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Mike E Jackson Balance Due: 43.00
30101 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Stephen L Jones Balance Due: 43.00
80101 09/18/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Maha M Maarouf Balance Due: 43.00
80101 09/22/2008 Drug Screen Non NIDA 5 Panel 1.00 4100 43.00
Orville L Massingill Balance Due: 43.00
80101 09/18/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Alyssa M Meyer Balance Due: 4
S0101 09/08/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
•`3�J
Alexander W Myers Balance Due: 43.00
>0101 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Terry D Myers Balance Due: 43.00
•`.;0101 09/02/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Nicole M Parr Balance Due: 43.00
0101 09/04/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Mark D Rice Balance Due: 43.00
e0101 09/11/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Carmen Saucedo Balance Due: 43.00
?'101 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Courtney A Schlaegel Balance Due: 43.00
£:0101 09/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
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.
3455031 Community Occupational Health Services
Terms
P.O. Box 19383
Indianapolis, IN 46219
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1012108 222368 Pre employment drug testing
1, 376.00
Total 1,376.00
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.
3455031 Community Occupational Health Services Allowed 20
P.O. Box 19383
Indianapolis, IN 46219
In Sum of
1,376.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 222368 4340700 1,376.00 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
20 -Oct 2008
'f►�p/11,"tA-)
Signature
1,376.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund