161319 07/11/2008 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $6,714.00
CARMEL, INDIANA 46032 P O BOX 19383
INDIANAPOLIS IN 46219 CHECK NUMBER: 161319
CHECK DATE: 7/1112008
DEPARTMENT... ACC OUNT PO NUM IN VOICE N UMBE R AMOUNT DE SC RI PTION
1046 4340700 212317 1,290.00 MEDICAL FEES
1047 4340700 212317 5, 080;;``;00 MEDICAL FEES
1125 4340700 212317 301:'00 MEDICAL FEES
1047 4340700 214802 43.00 MEDICAL FEES
I
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
317-355-6335
Tax ID 35-1955223 0 Nn r
Invoice
June 03, 2008
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 5/08
1411 E. 116th St.
Carmel, IN 46032-
Invoice 212317
Proc Code Service Date Description Quantity Charge Receip Adjust Balance
SO 101 05/16/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
R Shane Akridge Balance Due: 43.00
80101 05/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Katherine M Allerneier Balance Due: 43.00
X0100 05/16/2008 Drug Screen Rapid 5 Panel 1.00 49.00 49.00
T Crystal N Allen Balance Due; 49.00
S0101 05/12/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Elizabeth K Avenius Balance Due: 43.00
05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Melvin S Baird Balance Due: 43.00
M101 05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
I Brett J Barra Balance Due: 43.00
SO 10 1 05/15/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Nicholas M Barratt Balance Due: 43.00
0l 0 1 05/08/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Abigail L Benjamin Balance Due: 43.00
Invoice 4 212317 (continued) page 2
roc; Code Service Date Description Quantity Charge Receipt Adjust Balance
,50101 05/24/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
James C Berry III Balance Due: 43.00
so 101 05/15/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
MIchael J Berry Balance Due: 43.00
SO 101 05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
William J Brady Balance Due: 43,00
11
?0101 05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Joseph E Broerman Balance Due: 43.00
I Ol 05/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Stephanie D Broughton Balance Due: 43.00
80101 05/31/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Joshua W Browne Balance Due: 43.00
c10101 05/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
David E Butcher Balance Due: 43.00
05/13/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Andrew S Byers Balance Due: 43.00
80101 05/17/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Xinyi Cai Balance Due: 43.00
I
80101 05/18/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Cavya Chandra Balance Due: 43.00
0 10 1 05/01/2008 Drug Screen Non NIDA 5 Panel 1.00 43,00 43.00
Monica J Cochran Balance Due. 43-00
Xolol 05/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Melvin Conn -Baird Balance Due: 43.00
1
80101 05/14/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Robert W Corpus Balance Due: 43.00
Invoice 212317 (continued) page 3
Proc Code Service Date Description Quanti Charge Receipt Adjust Balance
8'o 101 05/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
1 Anthony J Cossell, Jr. Balance Due: 4 3.00
1 0101 05/24/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Heather L Courter Balance Due: 43.00
SO 101 05/28/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kevin J Courtney Balance Due: 43.00
80101 05/12/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Francis M Dixon Balance Due: 43.00
M 101 05/23/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Christopher R Ellison Balance Due: 43.00
r 01.01 05/14/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Laura. A Engle Balance Due: 43.00
80101 05/02 /2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Robert B English Balance Due: 43.00
};p 101
05/11/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
William A Fama, Jr Balance Due: 43.00
4
M101 05/15/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kristi S Fisher Balance Due: 43.00
-'0101 05/31/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Hannah V Flores Balance Due: 43.00
M101 0511912008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Michael R Forbes Balance Due: 43.00
S
;0101 05/21/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Heather D Frabutt Balance Due: 43.00
?Ol 0l 05/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Invoice 212317 (continued) page 4
Proc Code Service Date Description Quantity Charge Recei t Adjust Balance
Kara T Froemming Balance Due: 43.00
SO 101 05/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Joseph K Gardner Balance Due: 43.00
80101 05/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Benjamin R Gernhardt Balance Due: 43.00
W 101 05/06/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Steven T Goedde Balance Due: 43.00
130101 05/15/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Garrett D Goldman Balance Due: 43.00
t
S0101 05/21/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Melissa L Gordon Balance Due: 43.00
SO 101 05/07/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Clark R Green Balance Due: 43.00
80101 05/20/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Joshua R Greenlee Balance Due: 43.00
801 O 1 05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Nicholas T Greenlee Balance Due: 43.00
C,
s -"0101 05/13/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Ashley N Griffith Balance Due: 43.00
C
80101 05/31/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Paul M Grimm Balance Due: 43.00
80101 05/05/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
David P Hanover Balance Due: 43.00
:10101 05/20/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Tyler Hardcastle Balance Due: 43.00
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Invoice 2l23\7(ouubnucd) page 5
Proc Code Service Date Description Quanti Charge Receip Balance
80l0| 0581/2008 Drug Screen Non ND}A5Panel 1.00 43.00 43.00
JiugYuao He Balance Due: 43.00
88|O\ 05/07/2008 Drug Screen Non NIDA5Panel 1.00 43.00 4I00
Jcnnu�����orru �u�uooe0"c� 43.00
p
00101 05/27/2008 Drug Screen Non N[DA5Panel 1.00 43.00 43.00
Kayla AHoffman Balance Due:
80101 05/202008 Drug Screen Non lwU}/\5Panel }.00 43.00 43.00
Kathryn Mlfobo Balance Due: 43.00
80101 0508/2008 Drug Screen Non Y4O0A5 Puuc| ).00 43.00 43.00
Emily Homes Balance |0"e' 43.00
8010 1 05/15/2008 Drug Screen Non NlDA 5Puoc| 1.00 43.00 43.00
Melissa LHowland Balance Due: 43.00
1 :0101 05/13/2008 Drug Screen Non ND}f\5Panel |.00 43.00 43.00
Beurbcr��Dfodouo Balance Due: 43.00
11 0101
05/22/2008 Drug Screen Non N\DA5Panel 1.00 43.00 43.00
Laura BHull Balance Due: 43.00
%0101 05/30/2008 Drug Screen Non NlDA5Panel 1.88 43.00 43.00
Zack MJu"ooeods Balance Due: 43.00
�0101
05/002008 Drug Screen Non ND}A5Panel 1.00 4I00 43.00
Cbds1nphcc f�umtcr Balance Due: 43'00
i---------
601 05/15/2008 Drug Screen Non NlDA 5Puool 1.00 43.00 43.00
Kathryn 8Key Balance Due: 43.00
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LQ010 1 05/07D008 Drug Screen Non NU]/\jPanel |.00 43.00 43.00
Brandon CKidd Balance Due: 43.00
�0101 0507/2008 Dn/g Screen Non lH|D&5Panel 1.00 43.00 43.00
Ashley AKincaid Balance Due: 43.00
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Invoice 212317 (continued) page 6
'roc Code Service Date Description Quantity Charge Recei t Adiust Balance
£;0101 05/14/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Anastasia M Klauz Balance Due: 43.00
50101 05/21/2008 Drug Screen -Non NIDA 5 Panel 1.00 43.00 43.00
Christina M Klink Balance Due: 43.00
80101 05/24/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kaitlyn G Klootwyk Balance Due: 43.00
I
SO101 05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Joseph P Kluemper Balance Due: 43.00
so101 05/11/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Karen S Kosoglov Balance Due: 43.00
30101 05/17/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Christine A Larson Balance Due: 43.00
S
10101 05/01/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Abbey A Laskowski Balance Due: 43.00
.80101 05/01/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
David J Lebin Balance Due: 43.00
$0101 05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Keith A Ledbetter Balance Due: 43.00
i
31 O1 05/25/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Jessica L Leitch Balance Due: 43.00
?,0101 05/05/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Adam K Loyd Balance Due: 43.00
80101 05/06/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Katherine M Lunsford Balance Due: 43.00
00101 05/12/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
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Invoice 212317 (continued) page 7
,P roc Code Service Date Description Quantity Charge Receipt Adiust Balance
Daniel G Madia Balance Due: 43.00
80101 05/20/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Mitchell W Marquardt Balance Due: 43.00
50101 05/31/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Margo M McAuley Balance Due: 43.00
{)101 05/31/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Morgan M McAuley Balance Due: 43.00
SO101 05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Tyler J McClure Balance Due: 43.00
,0101 05/13/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Andrea M McComas Balance Due: 43.00
80101 05/13/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Tyler A McCune Balance Due: 43.00
R0101 05/13/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Andreas McGlan Balance Due: 43.00
IRO 101 05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Marguerite M Mckenzie Balance Due: 43.00
80101 05/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Dennis M McLean Balance Due: 43.00
'0101 05/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Katherine E Meyers Balance Due: 43.00
i
50101 05/08/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Katelyn M Modisett Balance Due: 43.00
10101 05/13/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Natalie R Moistner Balance Due: 43.00
l
Invoice 2l23l7(oondnucd) page 8
Proc Code Service Date Description Quantity Charge Receip 8�j� Balance
�A|0> 05/14/2008 Drug Screen Non NlDA 5Puncl 1.00 43.00 43.00
�V
Kenneth KXMosley Balance Due: 43.00
80|O\ 05/14/2008 Drug Screen Non NlDA5 Panel 1.00 43.00 43.00
�uqodu8��oUwo 0uluuoo0"e� 43.00
:38101 05/10/2008 Drug Screen Non NlDA5Panel 1.00 43.00 43.00
Bourber 08"ryby Balance Due: 43.00
�01 01 05/08/2008 Drug Screen NonNlDA 5Paoe} 1.00 43.00 43.00
^Cbrio,u�berTl�u8�,Jr' Balance Due: 43.00
M)0| 05/22/2008 Drug Screen 'Non N0&jPanel 1.00 43.00 43.00
Jeff Nasser Balance Due: 43.00
X�|0l 05/31/2008 Drug Screen Non NlD&5 Panel 1.00 43.00 43.00
KotelyoA Nuunm Balance Due: 43.00
s
0O\0l 0/16/2008 Drug Screen 'Non NIDA5Panel 110 43.00 43.00
Richard N*bring Balance Due: 43.00
�010 1 05/29/2008 Drug Screen Non N|D/\5Panel 1.00 43.00 43.00
Katherine 8Newberry Balance Due: 43.00
8,01 01 05/13/2008 Drug Screen Non NTDA5Panel 1.00 43.00 43.00
Dustin SO'Bo)d Balance Due: 43.00
8O\0| 05/06/2008 Drug Screen NonNlDA 5yvnc| 1�OO 43�00 43.00
c
Ales����'K�"D Balance Due: 43.00
�0
8()\O\ 05/06/2008 Drug Screen Non NID/\5Panel 1.00 43.00 43.00
��or�z���'��vU �uluooclNue� 43.00
�O}O) 05/08/2008 Drug Screen Non NlDA5Panel 1.00 4I00 43.00
Kelly E O'Hara Balance Due: 43.00
;O|0| 05/15/2008 Drug Screen NooN1DA 5Puuc| 1.00 43.00 42.00
Laura NYOhdigeo Balance Due: 43J00
90
Invoice 212317 (continued) page 9
Proc Code Service Date Description Quantity Charge Receipt Adiust Balance
0101 05/20/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kathryn F O'Rourke Balance Due: 43.00
80101 05/15/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Nolan W Pachcizrz Balance Due: 43.00
M101 05/18/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Alan M Paramore Balance Due: 43.00
e�101 05/15/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Devin A Pauley Balance Due: 43.00
0101 05/24/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
T
Joseph M Pavia Balance Due: 43.00
`�0101 05/20/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Bradley S Pearson Balance Due: 43.00
00101 05/01/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kaleen M Pesyna Balance Due: 43.00
0101 05/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Eric M Peterson Balance Due: 43.00
101 05/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Sara C Peterson Balance Due: 43.00
SO101 05/14/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Russell Pisarczyk Balance Due: 43.00
80101 05/22/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Michael A Poletika Balance Due: 43.00
S0101 05/20/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Preston P Porter Balance Due: 43.00
4�
0101 05/24/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
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Invoice 212317 (continued) page 10
Proc Code Service Date Description Quantity Charge Receipt Adiust Balance
Dan V Quakenbush Balance Due: 43.00
S0101 05/13/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Mary A Queisser Balance Due: 43.00
1:0101 05/31/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Michael J Radlick Balance Due: 43.00
-8 0101 05/17/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Ella R Raymont Balance Due: 43.00
$0101 05/16/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Emily E Rechin Balance Due: 43.00
0101 05/06/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Charles W Redmon Balance Due: 43.00
80101 05/14/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Julia A Reis Balance Due: 43.00
80101 05/11/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Lauren M Reising Balance Due: 43.00
80101 05/03/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Emily E Rice Balance Due: 43.00
80101 05/12/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Matthew J Ritter Balance Due: 43.00
r
80101 05/17/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Scott B Roberts Balance Due: 43.00
4;
0101 05/20/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Grace Roth Balance Due: 43.00
5 w.
a
80101 05/15/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kolten S Rowe Balance Due: 43.00
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Invoice 2\23l7(coutinued) page
�roc Code Service Date Description Quantity Charge Receipt 8�[� Balance
|O\ 05/02/2008 Drug Screen NouN7DA 5 Panel 1.00 43.00 43.00
Lindsay M0uzyoek Balance Due: 43.00
80101 05/17/2008 Drug Screen Non NUDA 5Panel |.00 43.00 43.00
Amanda MRussell Balance Due: 43.00
�0101
0580/2008 Drug Screen Non NDDA5Panel 1.00 43.00 43.00
/D678XX0
Casey M8cbuuk Balance Due: 43.00
80)0\
05/13/2008 Drug Screen Non N[DA5Panel 1.00 43.00 43.00
Jacob M8cbudcVuoWwmtru Ba Due: 43.00
80101 05/02/ 2008 Drug Screen Non NIDA5 Panel 110 4310 43.00
DuB8obiereober� Balance Due: 43.00
30101 05/14/2008 Drug Screen NonN[DA 59unel 1.00 43.00 43.00
Eric WSchneider Balance Due: 43.00
XU|Ol 0507/2008 Drug Screen Non N1D/\5Panel 1.00 43.00 43.00
David p8cboiedwrx Balance Due: 43.� 00
DO|0l 05/13/2008 Drug Screen l�ouNU}&5Panel l�OO 43�OO 43.00
Kelsey NSchulz Balance Due: 43.00
x
30101 05/202008 Drug Screen Non l4{D&5Panel 1.00 43.00 43.00
�utriuk��8cbuarur �u}u0000uo' 43
00
8 010 05/31/2008 Drug Screen Non NU]A 5Puue\ 1.00 43.00 43.00
0�oguo88uu}tbocp uluuow 0oe� 43.00
80101
05/03/2008 Drug Screen Non N[DA 5Yun6 |.00 43.00 43.00
f
Austin JSims Balance Due: 43.00
.�0101 05/29/2008 Drug Screen Non NlD/\5Panel 1.00 43.00 43.00
Anne CSommer Balance Due: 43.00
OO|Ol 05/24/2008 Drug Screen Non N|DA5Panel \.00 43.00 43.00
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8
Invoice 212317 (continued) page 12
P roc Code Service Date Description Quantity Charge Receipt Adiust Balance
Samuel W Spoerle Balance Due: 43.00
;0101 05/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Joshua M Stephens Balance Due: 43.00
$0101 05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Michael E Stevens Balance Due: 43.00
`)101 05/10/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Elyse T Strand Balance Due: 43.00
30101 05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Andrew M Stull Balance Due: 43.00
Y.
80101 05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
David R Sutter Balance Due: 43.00
g0101 05/05/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Shelly D Symmes Balance Due: 43.00
i
)10
1 05/28/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Sylvia Tawfik Balance Due: 43.00
80101 05/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Ryan D Thomas Balance Due: 43.00
80101 05/20/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Bradley A Thomason Balance Due: 43.00
M 101 05/09/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Jonathan N Thompson Balance Due: 43.00
:.0101 05/24/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Julie Troyer Balance Due: 43.00
3101 05/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Lucia M Walsh Balance Due: 43.00
Invoice 212317 (continued) page 13
Proc Code Service Date Description Quantity Charge Receipt Adjust Balance
80101 05/01/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Ronald A Weiss Balance Due: 43.00
101 05/23/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Olivia A Westermeier Balance Due: 43.00
50101 05/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Roy D Williams Balance Due: 43.00
80101 05/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Collin M Winkle Balance Due: 43.00
�0101 05/31/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Lauren A Woeste Balance Due: 43.00
"0) 101 05/08/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Lauren M Wright Balance Due: 43.00
80101 05/15/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Stephanie L Wright Balance Due: 43.00
1;0101 05/31/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Derek S Young Balance Due: 43.00
Invoice 212317 Balance Due: 6671.00
s:
PLEASE REMIT PAYMENT PROMPTLY
Cut and return with payment
-3 rPf
Please remit 6,671.00 to: Community Occupational Health e i s
P.O. Box 19383
Please place invoice number 212317 on check Indianapolis, IN 46219
:r Phone: 317 355 -6335
Community Occupational Health Services
P.Q. Box 19383
Indianapolis, IN 46219
317 -355 -6335
Tax ID 35- 1955223 JUN 12 2008
18�;
Invoice
June 06, 2008
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Cannel Clay Parks Recreation 5/08
1411 E. 116th. St.
Carmel, IN 46032-
Invoice 214802
Proc Code Service-Date Descrintinn Ouantity Champ Receipt Adjust Balance
80101 05/31/2008 Drug Screen Non N1DA 5 Panel 1.00 43.00 43.00
Cynthia Shank SSN: Balance Due: 43.00
Invoice 214802 Balance Due: 43.00
Cut and retum 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 Date Due
Indianapolis, IN 46219
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
06/03/08 212317 Pre- employment drug screening 301.00
06/03/08 212317 Pre employment drug screening 1,290.00
06 /03 /08 212317 Pre- employment drug screening 5,080.00
06/06/08 214802 Pre employment drug screening 43.00
Total 1 6,714.00
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
6,714.00
ti
ON ACCOUNT OF APPROPRIATION FOR
101 General 104 Program
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 212317 4340700 301.00 1 hereby certify that the attached invoice(s), or
1046 212317 4340700 1,290.00 bill(s) is (are) true and correct and that the
1047 212317 4340700 5,080.00 materials or services itemized thereon for
1047 214802 4340700 43.00 which charge is made were ordered and
received except
3 -Jul 2008
Signature
6,714.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund