HomeMy WebLinkAbout160308 06/10/2008 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
'JNE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $502.00
CARMEL, INDIANA 46032 P 0 BOX 19383
INDIANAPOLIS IN 46219
CHECK NUMBER: 160308
CHECK DATE: 6/10/2008
DEPARTMENT A CCOUNT P O NUMBER INVO NUMBER A MOU NT D ESCRIPTION
651 5023990 050208 72.00 OTHER EXPENSES
1046 4340700 2/08 129.00 MEDICAL FEES
1047 4340700 2/08 301.00 MEDICAL FEES
,I
f Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
317 -355 -6335
Tax ID 35- 1955223
r.
Invoice
March 04, 2008
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 2 -08
1411 E. 116th St.
Carmel, IN 46032
Invoice 204900
Proc Code Service Date Description Quantity Charge Receipt Adjust Balance
80101 02/14/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Teresa M Cepican Balance Due: 43.00
80101 02/25/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
William C Chrismond Balance Due: 43.00
80101 02/25/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Donnell R Lonberger Balance Due: 43.00
80101 02/28/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Juan Mercardo Balance Due: 43.00
80101 02/07/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
P Kyle A Patterson Balance Due: 4 3.00
80101 02/01/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Jessica M Penp. Balance Due: 43.00
80101 02/18/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Sarah E Peterson Balance Due: 43.00
80101 02/14/2008 Drug Screen Non. NIDA 5 Panel 1.00 43.00 43.00
3
Cathy Sands Balance Due: 43.00
t REGETNf f i'
JUN 0 4 2.008 MAy e 2008
R
BY:
Invoice 204900 (continued) page 2
...d
Oroc Code Service Date Description Quanti Charge Receipt Adjust Balance
80101 02/14/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Sarah L Sheafer Balance Due: 43.00
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80101 02/13/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Cinda L Thompson Balance Due: 43.00
Invoice 204900 Balance Due: 430.00
PLEASE REMIT PAYMENT PROMPTLY
Pt
,t
I
Cut and return 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.
Terms
355031 Community Occupational Health Services
Date Due
PO Box 19383
Indianapolis, IN 46219
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
129.00
03/04/08 2 -08 Employment drug testing 301.00
03/04/08 2 -08 Employment drug testing
Total 430.00
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
PO Box 19383
Indianapolis, IN 46219
In Sum of
430.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 2 -08 4340700 129.00 1 hereby certify that the attached invoice(s), or
1047 2 -08 4340700 301.00 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
4 -Jun 2008
0
Signatu r6/
430.00 Business Services Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219 I'
317- 355 -6335 C
Tax ID 35- 1955223 AQ,
Invoice
May 02, 2008
Bill to: Shelly Lingelbaugh For: Carmel Utilities
Carmel Utilities 4/08
1 Civic Square
Carmel, IN 46032
Invoice 211 396
1
5, Code Service Date Description Quantity Charge Receipt Adiust Balance
04/22/2008 Whisper Test 1.00 7.00 7.00
81002 04/22/2008 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00
99173 04/22/2008 Snellen 1.00 7.00 7.00
99386 04/22/2008 DOT/PPCL Exam 1.00 51.00 51.00
Eric S Robinson Balance Due: 72.00
Invoice 211396 Balance Due: 72.00
PLEASE REMIT PAYMENT PROMPTLY
U,
Cut and return with payment
VOUCHER 085635 WARRANT ALLOWED
35503.1 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
050208 01- 7042 -06 $72.00
Voucher Total $72.00
Ost 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
f�
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 6/4/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/4/2008 050208 $72.00
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