161776 07/23/2008 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CRRK AMOUNT: $144.00
CARMEL, INDIANA 46032 P 0 BOX 19383
INDIANAPOLIS IN 46219 CHECK NUMBER: 161776
CHECK DATE: 7/23/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOU DESCRIPTION
651 5023990 215316 144.00 OTHER EXPENSES
i
Communit y Occupational Health Services J
P.O. Box 19383 0 I A
Indianapolis, IN 46219 3 e F 4 C
f 317- 355 -6335
Tax ID 35- 1955223
Invoice
July 03, 2008
Till to: Shelly Lingelbaugh For: Carmel Utilities
Carmel Utilities 6/08
1 Civic Square
Carmel, IN 46032-
w
Invoice 215316
'roc Code Service Date Description Quantity Charge Receipt Adjust Balance
06/26/2008 Whisper Test 1.00 7.00 7.00
1002 06/26/2008 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00
?9173 06/26/2008 Snellen 1.00 7.00 7.00
99386 06/26/2008 DOT/PPCL Exam 1.00 51.00 51.00
Robbie L Kinkead Balance Due: 72.00
06/09/2008 Whisper Test 1.00 7.00 7.00
`;1002 06/09/2008 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00
09173 06/09/2008 Snellen 1.00 7.00 7.00
':9386 06/09/2008 DOT /PPCL Exam 1.00 51.00 51.00
Harold B Oliver Balance Due: 72.00
Invoice 215316 Balance Due: 144.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and return with payment
Please remit 144.00 to Community Occupational Health Services
Please place invoice number 215316 on check P.O. Box 19383
Indianapolis, IN 46219
Phone: 317 355 -6335
VOUCHER 085907 WARRANT ALLOWED
355031 IN SUM OF
COMMUNITY OCCUPATIONAL HEALTI
PO BOX 19383
INDIANAPOLIS, IN 46219
4
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
215316 01- 7042 -06 $144.00
Voucher Total $144.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995) j,
ACCOUNTS PAYABLE TOUCHER a
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc. y
i
Payee b
355031
COMMUNITY OCCUPATIONAL HEALTH Purchase Order No.
PO BOX 19383 Terms
INDIANAPOLIS, IN 46219 Due Date 711512008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/15/2008 215316 $144.00
I hereby certify that the attached invoice(s), or bill(s) is (are) true and t.
correct and I have audited same in accordance with IC 5- 11- 10 -1.6 di
Date Officer