157024 03/05/2008 i
CITY OF CARMEL, INDIANA VENDOR 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH M& AMOUNT: $514.00
i` CARMEL, INDIANA 46032 P 0 BOX 19383
.ate INDIANAPOLIS IN 46219 CHECK NUMBER: 157024
CHECK DATE: 3/5/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4340700 203077 387.00 MEDICAL FEES
1047 4340700 203077 127.00 MEDICAL FEES
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Community Occupational Health Services
P O. Box 19383
Indianapolis, IN 46219
317- 355 -6335
i Tax ID 35- 1955223
f_
F y: 5 2008
Invoice
February 04, 2008
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation Jan 2008
1411 E. 116th St.
Carmel, IN 46032-
1
Invoice 203077
Proc Gode Service Date Description Quantity Charge Receipt Adjust Balance
80101 01/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Christopher W Bell Balance Due: 43.00
80101 01/31/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Summer M Breskow Balance Due: 43.00
80101 01/12/2008 Drug Screen Non NIDA 5 Panel 1.00 42.00 4200
Kiley R Burlas Balance Due: 42.00
80101 01/19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Alisha K Burnstein Balance Due: 43.00
80101 01/23/2008 Drug Screen Non NIDA 5 Panel 100 43.00 43.00
F Sharon I Fowlkes Balance Due: 43.00
80101 01/29/2008 Drug Screen Non NIDA 5 Panel 1 00 4300 43.00
Adrienne Hall Balance Due: 43.00
80101 01/25/2008 Drug Screen Non NIDA 5 Panel 1.00 4300 4300
Leanne M Heeg Balance Due: 43.00
80101 01/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
t
Matthew J Lindblom Balance Due: 43.00
FUND
I)EP'r FUND Pq
LINE 3 800 (o��
DEPT
DESC
LINE �3 X0'1
3� DESC
1,91
Invoice 203077 (continued) page 2
Proc Code Service Date Description Quantity Charge Recei t Adjust Balance
80101 01/24/2008 Drug Screen Non NIDA 5 Panel 1.00 4300 43.00
Nicholas J Manuszak Balance Due: 43.00
180101 01/31/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Cecelia Rice Balance Due: 43.00
80101 01/31/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Julie E Spencer Balance Due: 43.00
'80101 01/ Drug Screen Non NIDA 5 Panel 1 00 42.00 42.00
Stephanie N Walstrom Balance Due: 42.00
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Invoice 203077 B alance ,Due: 514.00
PLEASE REMIT PAYMENT PROMPTLY
6-0
s
r_ C ut and ret urn with payment
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
317- 355 -6335
Tax ID 35- 1955223
Invoice
February 04, 2008
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation Jan 2008
1411 E. 116th St.
Carmel, F T 46032-
Invoice 203077
Proc, Gode Service Date Description Quantity Charge Recei t Adiust Balance
80101 01/30/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 i O I 1 4300
Christopher W Bell Balance Due: 43.00
80101 01/31/2008 Drug Screen Non NIDA 5 Panel 100 43.00 1 43.00
Summer M Breskow Balance Due: 43.00
80101 01/12/2008 Drug Screen Non NIDA 5 Panel 1.00 4200 i u j 4200
I Kiley R Burlas Balance Due: I 42.00
80101 01%19/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 b� 43.00
Alisha K Burnstein Balance Due: 43.00
80101 01/23/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 (btf 4300
1 Sharon I Fowlkes Balance Due: t 43.00
80101 01/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 l D�4 1 43.00
Adrienne Hall Balance Due: 43.00
80101 01/25/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00
Leanne M Heeg Balance Due: 43.00
80101 01/29/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 I 4300
Matthew J Lindblom Balance Due: 43.00
Invoice 203077 (continued) page 2
Proc Code Service Date Description Quantity Charge Receipt Adiust Balance
801-01 01/24/2008 Drug Screen -'Non NIDA 5 Panel 1.00 4300 t 43.00
Nicholas J Manuszak Balance Due: 43.00
80101 01 %31 /2008 Drug Screen Non NIDA 5 Panel 1 00 43 00 O�� 43.00
Cecelia Rice Balance Due: 43.00
80101 01/31/2008 Drug Screen Non NIDA 5 Panel 100 4300 t j 4300
Julie E Spencer Balance Due: U l 43.00
80101 01/07/2008 Drug Screen Non NIDA 5 Panel 1 00 4200 OL I 4200
Stephanie N Walstrom Balance Due: 42.00
L.voice 203077 Balance Due: 514.00
PLEASE REMIT PAYMENT PROMPTLY
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Cut and return with payment I
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 I Number I (or note attached Invoice(s) or bill(s)) Amount
04- Feb -08 I 203077 lEmployment drug testing ESE, Rec) 51400
Total 514.00
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
1 20
Clerk- Treasurer
I
Voucher No Warrant No
355031 Community Occupational Health Services Allowed 20
PO Box 19383
Indianapolis, IN 46219
In Sum of
514.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO #or I INVOICE NO (ACCTWTITLEI AMOUNT Board Members
Dept J
1046 i 203077 I 4340700 i 387.00 1 hereby certify that the attached invoice(s), or
1047 i 203077 I 4340700 I 12700 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
i I received except
29 -Feb 2008
Signature
514.00 66+61ness series MaRager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund