HomeMy WebLinkAbout202956 10/25/2011 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CHE AMOUNT: $659.00
CARMEL, INDIANA 46032 P O BOX 19383
INDIANAPOLIS IN 46219 CHECK NUMBER: 202956
CHECK DATE: 10/25/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 301964 540.00 MEDICAL FEES
1125 4340700 301964 45.00 MEDICAL FEES
1201 4358800 303551 74.00 TESTING FEES
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
Phone: 317 355 -6335
FEIN: 35- 1955223
d
Invoice
October 06, 2011
Bill to: Jim Spelbring For: Cai Utilities
Carmel Utilities 9/11
1 Civic Square
Carmel, IN 46032-
Invoice 303551
Proc Code Date Description Qty Charge Receipt Adiust Balance
09/21/2011 Whisper Test 1.00 7.00 7.00
S1002 09/21/2011 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00
99173 09/21/2011 Snellen 1.00 7.00 7.00
99356 09/21/2011 DOT /PPCL Exam 1.00 53.00 53.00
Joseph W Faucett XXX -XX -6198 Balance Due: 74.00
Invoice 303551 Balance Due: 74.00
PLEASE REMIT PAYMENT PROMPTLY
D Q
OCT 24 2011
By
Cut and return with payment
Please remit 74.00 to Conmlunity Occupational Health Services
P.O. Box 19383
Please place invoice number 303551 on check Indianapolis, IN 46219
Phone: 317 355 -6335
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/06/11 303551 $74.00
I 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.
ALLOWED 20
Community Occupational Health Services
IN SUM OF
PO Box 19383
Indianapolis, IN 46219
$74.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
I hereby certify that the attached invoice(s), or
21677 303551 43- 588.00 $74.00
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
Monday, October 24, 2011
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
Phone: 317 355 -6335
FEIN: 35- 1955223
Invoice
October 06, 2011
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Cannel Clay Parks Recreation 9/11
1411 E. l 16th St.
Carmel, IN 46032-
Invoice 301964
Proc Code ICD9 Date Description Qty Charge Receipt Ad'lust Balance
31647 1) 883.0 09/2S/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
2) E968.7
Alyssa C Agresta Balance Due: S 45.00
31647 09/02/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Amy E Baldauf Balance Due: 5 45.00
316=47 09/21/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
January C Hines Balance Due: 4
I
31647 09/2S/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 A 45.00
Dawn R Kopper Balance Due: �1� 45.00
I
31647 09/14/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jamarr Moffett Balance Due: S 45.00
31647 09/16/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Amanda Monaghan Balance Due: 4 5.00
31647 09/21/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jennifer K Redkey- Choe Balance Due: 5 45.00
31647 09/21/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Adrianne C Richard Balance Due: S 45.00
31647 09/21/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Caitlin Skipper Balance Due: 5 45.00
31647 09/01/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Joylynn Townsend Balance Due: S 45.00
31647 09/14/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Savannah J Vanwhy Balance Due: S 45 .00
31647 09/15/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Invoice 301964 (continued) page�2
Leland Watson Balance Due: 45.00
31647 09/07/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Carrie Williams Balance Due: 45.00
Invoice 301964 Balance Due: 585.00
PLEASE REMIT PAYMENT PROMPTLY
Purchase
Description ;9.
P.O.# PorF
O C T 2011
Buc!get
Line Descr
III o
Purchaser to
ApprovalDate �o I
V3V 0 70 0 0
�u�i- 99 �3yo7oo �syo.ov
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.
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
10/6/11 301964 Pre-employment drug testing 45.00
10/6111 301964 Pre employment drug testing 540.00
Total 585.00
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
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
P.O. Box 19383
Indianapolis, IN 46219
In Sum of
585.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund 108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 301964 4340700 45.00 1 hereby certify that the attached invoice(s), or
1081 -99 301964 4340700 540.00 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
20 -Oct 2011
V A I J&M-rn D/L--)
Signature
585.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund