164201 09/30/2008 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH gg
po CARMEL, INDIANA 46032 P O BOX 19383 CK AMOUNT: $1,462.00
INDIANAPOLIS IN 45219 CHECK NUMBER: 164201
CHECK DATE: 9/3012008
DEPARTMENT ACCOUNT PO NUM IN NU MBER AMOU DESCRI
1046 T 4340700 219614 860.00 MEDTCAL FEES
1047 4340700 219614 602.00 MEDTCAL FEESs
Invoice 219614 (continued) page 3
Bruce M Russell Balance Due: 43.00
`;0101 08/28/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kathryn E Schwoerer Balance Due: 43.00
0101 08/01/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Jamaica Shaffer Balance Due: 43.00
$0101 08/02/2008 Drug Screen -'Non NIDA 5 Panel 1.00 43.00 43.00
Robert M Shea Balance Due: 43.00
30101 08/07/2008 Drug Screen Non. NIDA 5 Panel 1.00 43.00 43.00
Monique M Smith Balance Due: 43.00
n101 08/22/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Joseph D Swiderski Balance Due: 43.00
P, Q101 08/09/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Emily K Taylor Balance Due: 43.00
30101 08/22/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Margaret R Uland Balance Due: 43.00
$0101 08/16/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Elizabeth F Umstead Balance Due: 43.00
;0101 08/26/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Sinclair .P Wheeler Balance Due: 4 3.00
Invoice 219614 Balance Due: 1462.00
PLEASE REMIT PAYMENT PROMPTLY
J�.
13
s Cut and return with payment
Community Occupational Health Services
Y� P.O. Box 19383
Indianapolis, IN 46219 Purchase r
0� 317 -355 -6335 description Y
�V4�� Tax ID 35- 1955223 P.O. t P or F
co .1 C) y 6 Bud !he t�
1t j tine Date b
Invoice 0���
Date
September 04, 200
fill. to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 8 -08 7SE 1411 E. 116th St. Y 6 2008
Carmel, IN 46032-
Invoice 219614 BY.
Proc Code Service Date Description Quantity Charge Receipt Adiust Balance
1 10101 08/21 /2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Melissa L Alexander Balance Due: 43.00
IS 0101 08/15/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Mick J Barton Balance Due: 43.00
80101 08/02/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Lacey M Basarich Balance Due: 43.00
0101 08/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Chelsea A Blow Balance Due: 43.00
80101 08/16/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Robert Brinston Balance Due: 43.00
80101 08/04/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Amanda R Brittain Balance Due: 43.00
°0101 08/11/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
�e5
Benjamin L Balance Due: 43.00
0101 08/12/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Jennifer L Burnett Balance Due: 43.00
?101 08/26/2008 Drug Screen Non NIDA 5 Panel 1.00 43 -00 43.00
,3
Sarah E Cook Balance Due: 43.00
v0101 08/20/2008 Dnrg Screen Non NIDA 5 Panel 1.00 43.00 43.00
C
i=
Invoice 4 219614 (continued) page 2
Kara C Eades Balance Due: 43.00
I
80101 08/02/2008
Drug Screen Non NIDA 5 Panel 1.00 43,00 43.00
David B Jackson Balance Due: 43.00
1 80101 08/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Marcia A Klapper Balance Due: 43.00
I SO 10 1 08/07/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Monica S Lee Balance Due: 43.00
S0101 08/23/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Anna M Leno Balance Due: 43.00
r ;1101 08/01/2008 Drug Screen Non NIDA 5 Panel 1.00 43-00 43,00
Afang Li Balance Due: 43.00
S0101 08/28/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Jessica R Mayo Balance Due: 43.00
80101 08/13/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Michael Moon Balance Due: 43.00
08/23/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43,00
Vanessa NI Norman Balance Due: 43.00
08/28/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Rochelle L Paquette Balance Due: 43.00
80101 08/12/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Maurice A Perkins Balance Due: 43.00
80101 08/26/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Holly E Perlin-Grubb Balance Due: 43.00
8010i 08/06/2008 Drug Screen Non NiDA 5 Panel 1.00 43.00 43.00
Christian V Polk Balance Due: 43.00
56101 08/26/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Ben D Powell Balance Due: 43.00
0101 08/07/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43,00
Brenton Robinson Balance Due: 43.00
N10 1 08/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
SAP 1. ®2008
FluK
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 Date Due
Indianapolis, IN 46219
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
09/04/08 219614 Pre employment drug screening 860.00
09/04/08 219614 Pre employment drug screening 602.00
Total 1,462.00
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
1,462.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 219614 4340700 860.00 1 hereby certify that the attached invoice(s), or
1047 219614 4340700 602.00 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 -Aug 2008
Signature
1,462.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund