202082 09/27/2011 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH M& AMOUNT: $1,125.00
CARMEL, INDIANA 46032 P 0 BOX 19383
«o INDIANAPOLIS IN 46219 CHECK NUMBER: 202082
CHECK DATE: 9/27/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 299419 1,035.00 MEDICAL FEES
1091 4340700 299419 45.00 MEDICAL FEES
1125 4340700 299419 45.00 MEDICAL FEES
Community Occupational Health Services
P.O. Box 19383
t Purchase Indianapolis, IN 46219
D �S �2f OFEIN: 35- 1955223 hone: 317- 355 -6335
escripti P.O.
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Budget 7
Line Descr c e U►'U TWO
Purchase
Approval Invoice
Date
-4Y- 3 yO .September 06, 2011
Bill to: Lynn Ru0ssell y 3 p `1D -4 CGE C)o For: Cannel Clay Parks Recreation
Cannel Clay Parks& Recreation VO s y S 6() 8-11
1411 E. 1.16th St. �r
Carmel, IN 46032-
Invoice 299419
Proc Code ICD9 Date Description Qt! Charge Receipt Adjust Balance
31647 08/31/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
S Lorne M Baxter Balance Due: 4 5.0 0
31647 08/04/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
j Brittany E Burt Balance Due: 45.
31647 08/11/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Joseph R Castillo Balance Due: 45.00
31647 08/02/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Alyssa R Clark I3alance Due: 4
31647 08/03/201 l Drug Screen Non NIDA 5 Panel 1.00 S 45.00 45.00
Tabitha M Crittendon Balance Due: 45.00
31647 08/19/2011 Drug Screen Non NIDA 5 Panel 1.00 S 45.00 45.00
Georgianna Edwards Balance Due: 45.
31647 08/23/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 4 f 5 0
�i 7 f'
Jennifer L Gerber Balance Due: 5.00
31647 08/03/2011 Drug Screen Non N I DA 5 Panel 1.00 45.00 45.00
Brandon Green Balance Due: 45.00
31647 08/20/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Megan K Grubaugh Balance Due: 45.00
31647 08/1 1 /2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Anne N Ilosek Balance Due: 45.00
31647 08/11/2011 Drug Screen Non N I DA 5 Panel 1.00 45.00 45.00
Jessica M Irani Balance Due: 45
31647 08/17/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Invoice 299419 (continued) page 2
Andrew A Jaggers Balance Due: 45.00
31647 08/17/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Savannah M Krauss Balance Due: 45.00
31647 08/12/2011 Drug Screen Non NIDA 5 Panel 1.00 j 45.00 45.00
Glhassan S Maarouf Balance Due: 45.00
31647 08/01/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Malcolm E McIntyre Balance Due: 4 5.0 0
31647 08/04/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Ryan Newton Balance Due: 45.00
31647 08/04/20t I Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Shruthee Rajendran Balance Due: 45.00
31647 08/1 l /201 1 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Brittany R Rowe Rent Balance Due: 45.00
31647 1) 847.2 08/24/2011 Drug Scrccn Non NIDA 5 Panel 1.00 45.00 45.00
2) E927.8�
Craig A Smith Balance Due: 45.00
31647 08/01/2011 Drug Screen Non NIDA 5 Panel 1.00 e 45.00 45.00
Kyle.] Sokalick Balance Due: 45.00
31647 08/18/2011 Drug Screen -Non NIDA 5 Panel 1.00 J 45.00 45.00
Kiefer I Summers Balance Due: 45.00
31647 08/29/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
�Zackery J Tyler Balance Due: 45.00
31647 08/24/2011 Drug Screen Non NIDA 5 Panc1 1.00 5 45.00 45.00
Blake M Weaver Balance Due: 4 5.00
31647 08/04/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Tiffany Wli<eelen Balance Due: 45.00
31647 08/04/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
On Yee Anna Yu Balance Due: 45.
Invoice 299419 Balance Due: 1125.00
Purchase
Description PLEASE REMIT PAYMENT PROMPTLY
P.O.# PorF
r�
Budg `�d
Line Descr R
Purchaser Date
Approval Date
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
916111 299419 Pre-employment drug testing 45.00
9/6111 299419 Pre-employment drug testing 1,035.00
916111 299419 Pre-employment drug testing 45.00
Total 1,125.00
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