159836 05/28/2008 CITY OF CARMEL, INDIANA VENDOR. 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CHE CK AMOUNT: $1,204.00
GARMEL, INDIANA 46032 P 0 BOX 19383
INDIANAPOLIS IN 46219 CHECK NUMBER: 159836
CHECK DATE: 5/28/2008
DEPARTMENT ACCO PO N I NVOICE N AMOUNT DESCRIPTION
1046 4340700 209915 86.00 MEDICAL FEES
1047 4340700 209915 946.00 MEDICAL FEES
1125 4340700 209915 172.00 MEDICAL FEES
•s
Invoice 209915 (continued) page 3
P roc Code Service Date Description Quantity Charge Receipt Adjust Balance
Megan L Peterson Balance Due: 43.00
s U 101 04/04/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Ian A Rose Balance Due: 43.00
�0101 04/03/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Sarah A Schinbeckler Balance Due: 43.00
$0101 04/12/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Paula J Schlemmer Balance Due: 43.00
%�0101 04/04/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
T lies Sper.us Ba.ance Due:
?f
8119101 04/16/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kristin L Strychalski Balance Due: 43.00
0 101 04/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kathleen A Walker Balance Due: 43.00
'I-
80101 04/2812008 Drug Screen Non NIDA 5 Panel 1.00 43 -00 4100
Ahmad A Zayed Balance Due: 43.00
Invoice 209915 Balance Due: 1204.00
PLEASE REMIT PAYMENT PROMPTLY
TF
MAY 5 2008 IZ d. O(7
0 7
n Cut and return with payment
RE��T Community Occupational Health Services
P.O. Box 19383
MAY 0 6 2008 Indianapolis, IN 46219
i 317 -355 -6335
Tax ID 35- 1955223
Invoice
May 02, 2008
BlWto: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 4 -08
1.411 E. 116th St.
Carmel, IN 46032
Invoice 209915
Proc Code Service Date Description Quantity Charge Receipt Adiust Balance
801.01 04/18/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43 -00
Lauren E Allan Balance Due: 43.00
s
80101 04/18/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Brian Basey Balance Due: 43.00
0101 04/28/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Meredith L Bentley Balance Due: 43.00
E0101 04/01/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
K949834
Holly A Courier Balance Due: 43.00
$0101 04/03/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
'r
Lois S Cox Balance Due: 43.00
�0101 04/04/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Hannah M Dierks Balance Due: 43.00
S 04/18/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kathryn E Feller Balance Due: 43.00
IS0101 04/11/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Betsy M Fowler Balance Due: 43.00
J
MAY 3 5 2008
Invoice 209915 (continued) page 2
Proc Code Service Date Description Quantity Charge Receipt AS i Balance
,soloi 04/14/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Taylor L Havill Balance Due: 43.00
04/15/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Mike E Jackson Balance Due: 43.00
04/03/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Michael A Lantz Balance Due; 43.00
S0101 04/04/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Matthew A Leber Balance Due: 43.00
80101 04/10/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Zachary M Lester Balance Due: 43.00
80101 04/04/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Kevin M Loiselle Balance Due: 43.00
R0101 04/11/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Severiano G Lopez Balance Due: 43-00
0101 04/09/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Corey W Manuel Balance Due: 43.00
80101 04/04J2008 Drug Screen Non NIDA 5 Panel 1.00 43,00 43.00
Michael S Mestetsky Balance Due: 43.00
20101 04/05/2008 Drug Screen Non NIDA 5 Panel 1.00 43,00 43.00
Ashley M Molina Balance Due: 43.00
6 0101
04/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Tyler R Pauley Balance Due: 43.00
04/29/2008 Drug Screen Non- NIDA 5 Panel 1.00 43.00 43.00
Laura L Perry Balance Due: 43.00
80101 04/03/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
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
PO Box 19383 Date Due
Indianapolis, IN 46219
Invoice invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
02- May -08 209915 Employment drug testing 1,204.00
Total I 1,204.00
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.
35.5031 Community Occupational Health Services Allowed 20
PO Box 19383
Indianapolis, IN 46219
In Sum of
1,204.00
ON ACCOUNT OF APPROPRIATION FOR
104 101
PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members
Dept
1125 209915 4340700 172.00 1 hereby certify that the attached invoice(s), or
1046 209915 4340700 86.00 bill(s) is (are) true and correct and that the
1047 209915 4340700 946.00 materials or services itemized thereon for
which charge is made were ordered and
received except
23 -May 2008
Sign u
1,204.00 Business e s Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund