160805 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH SE��[
el CARMEL, INDIANA 46032 P o BOX 19383 CHECK AMOUNT: $144.00
u� Lo INDIANAPOLIS IN 46219 CHECK NUMBER: 160805
CHECK DATE: 6/25/2008
DEPARTMENT ACC PO NUMB INV NUMBER AMOU DESCRIP
,651 5023990 213217 144.00 OTHER EXPENSES
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
317- 355 -6335
Tax ID 35- 1955223
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Invoice
June 03, 2008
`3111 to: Shelly Lingelbaugh For: Carmel Utilities
Carmel Utilities 5/08
1 Civic Square
Carmel, IN 46032-
Invoice 213217
Proc Code Service Date Description Quantity Charge Recei t Adjust Balance
05/20/2008 Whisper Test 1.00 7.00 7.00
81002 05/20/2008 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00
09173 05/20/2008 Snellen 1.00 7.00 7.00
99386 05/20/2008 DOT/PPCL Exam 1.00 51.00 51.00
Jeffery Cooper Balance Due: 72.00
05/ 13/2008 Whisper Test 1.00 7.00 7.00
002 05/13/2008 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00
t?9173 05/13/2008 Snellen 1.00 7.00 7.00
386 05/13/2008 DOT/PPCL Exam 1.00 51.00 51.00
Dennis M Russ Balance Due: 72.00
Invoice 213217 Balance Due: 144.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and return with payment
Please remit 144.00 to: Community Occupational Health Services
P.O. Box 19383
Please place invoice number 213217 on check Indianapolis, IN 46219
Phone: 317 -355 -6335
VOUCHER 085735 WARRANT ALLOWED
355031 IN SUM OF
COMMUNITY OCCUPATIONAL HEALTI
PO BOX 19383
INDIANAPOLIS, IN 46219
A.�
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
213217 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)
ACCOUNTS PAYABLE VOUCHER
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.
Payee
355031
COMMUNITY OCCUPATIONAL HEALTH Purchase Order No.
PO BOX 19383 Terms
INDIANAPOLIS, IN 46219 Due Date 6/17/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/17/2008 213217 $144.00
7
iu
hereby certify that the attached invoice(s), or bill(s) is (are) true and
,orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer