HomeMy WebLinkAbout199882 08/03/2011 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CHE�SER
TI CARMEL, INDIANA 46032 P O BOX 19383 K AMOUNT: $780.00
INDIANAPOLIS IN 46219
CHECK NUMBER: 199882
CHECK DATE: 8/3/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4340700 295216 630.00 MEDICAL FEES
1125 4340700 295216 150.00 MEDICAL FEES
Invoice 295216 (continued) page 2
Jessica C Miller Balance Due: 45.00
31647 06/30/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Shannon L Mullins Vann Balance Due: 45.00
31647 06/27/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Alexia L Ohne Balance Due: n 45.00
10544 0002 06/03/2011 Metaxolone 800mg 20 1.00 103.00 103.00
10544 0163 -30 06/03/2011 Diclofenae Potassium 50mg; #30 1.000 107.00 p 107.00
L E Opdahl Balance Due:
210.00
31647 06/04/201 1 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Dior 13 Sharp Balance Due: 4
31647 1) 920 06/21/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
2) 919.0
Allison M Smith Balance Due: v 45.00
31647 06/01/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Taylor A Smith Balance Due: 45 .0 0
Invoice At 295216 Balance Due:
PLEASE REMIT PAYMENT PROMPTLY 7 O 0
Purchase r D�
Description I�i.l l -1 rrU!
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Purchaser ate 1
Appro val Date 6 %c Ll
Cut and return with payment
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
Phone: 317 355 -6335 r
FEIN: 35- 1955223
JUL 0 2011
BY: Invoice
July 06, 2011
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Cannel Clay Parks Recreation 6 -11
1411 E. 116th St.
Carinel, IN 46032-
...w.-
Invoice 295216
Proc Code ICD9 Date Description Qty Charge Recei t Adjust Balance
31647 06/01/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Eric J Abbenhaus Balance Due: V 45.00
31647 06/01/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Robert C Bowers Balance Due: 45.00
31647 06/04/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Megan E Bowker Balance Due: 45.00
31647 06/06/201 1 Drug Screen Non NIDA 5 Panel 1.00 45.00. 45.00
82075 06/06/2011 Breath Alcohol Test 1.00 30.00 30.00
Andrew W Burnett Balance Due: 75
31647 06/1312011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Alec M Funke Balance Due: 45.00
31647 06/28/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Richard C Henry Balance Due: 45
31647 1) 959.3 06/01/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
2) E917.9
Michele C Jones Balance Due:
45.00
31647 06/07/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Carol K Kamps Balance Due: l 4 5.00
31647 06 /17/201 1 Drug Screen Non NIDA 5 Panel 1.00 45.00 V 1 45.00
82075 06/17/2011 Breath Alcohol Test 1.00 0.00 30.00
Joshua A Koehl Balance Due: 75
31647 06/30/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Michael W Kremer Balance Due: 45.00
31647 06/18/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
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
P.O. Box 19383
Indianapolis, IN 46219
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
7/6/11 295216 Pre-employment drug testing 150.00
7/6/11 295216 Pre-employment drug testing 630.00
Total 780.00
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
780.00
ON ACCOUNT OF APPROPRIATION FOR
101 General 108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 295216 4340700 150.00 1 hereby certify that the attached invoice(s), or
1082 -99 295216 4340700 630.00 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
26-Jul 2011
W
Signature
780.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund