203815 11/21/2011 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $662.00
o- CARMEL, INDIANA 46032 P 0 BOX 19383
INDIANAPOLIS IN 46219
CHECK NUMBER: 203815
CHECK DATE: 11/21/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 304125 450.00 MEDICAL FEES
1091 4340700 304125 45.00 MEDICAL FEES
1201 4358800 304462 74.00 TESTING FEES
1201 4358800 306100 93.00 TESTING FEES
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
Phone: 317- 355 -6335
FEIN: 35- 1955223
Invoice
November 03, 2011
Bill to: Sue Coy For: Cannel Administration
Cannel Administration
1 Civic Square
Carmel, IN 46032
Invoice 306100
Proc Code Date Description Qty_ Charge Receipt Adjust Balance
58160- 0842 -43 09/13/2011 T -DAP 1.00 93.00 93.00
Andrew D Wyant XXX -XX -8585 Balance Due: 93.00
Invoice 306100 Balance Due: 93.00
PLEASE REMIT PAYMENT PROMPTLY
D Q
NOV 21 2011
By
Cut and return with payment
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))
11/03/11 304462 $74.00
11/03/11 306100 $93.00
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
$167.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1201 304462 43- 588.00 $74.00 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1201 306100 43- 588.00 $93.00
materials or services itemized thereon for
which charge is made were ordered and
received except
Wednesday, November 16, 2011 A
6
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 Purchase
Phone: 317- 355 -6335 Description r A, e s
FEIN: 35- 1955223 P.O.
Pore
Budet
Line cr
Purchaser to
Invoice Approval Date
November 03, 2011 1 4 y 3 D 7 UU -j �(S, 0 v
lc��l- y3 07U ��S000
Bill to: Lynn Russell For: Cannel Cl�y Parks Recreation
Cannel Clay Parks Recreation 10/11
1411 E. 116th St.
Cannel, IN 46032-
-11 w.,
Invoice 304125
Proc Code ICD9 Date Description Qty Charge Receipt Adjust Balance
31647 10/26/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Monica Awad Balance Due: 45.00
31647 10/06/2011 Drug Screen Non NIDA 5 Panel I.00 45.00 45.00
Jonathan R Baney Balance Due: C 45.00
31647 10/11/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Belen M Cassani Balance Due: 45.00
31647 10/13/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jazmin Childress Balance Due:
45.00
31647 10/06/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Karen M de Boer Balance Due: 45.00
31647 10/05/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Dana L Ford Balance Due: L 45.00
31647 10/19/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Elizabeth Graupner Balance Due: 45.00
31647 10 /1 1/201 1 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Latoya C Neely Balance Due: C 45.00
31647 10/25/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jordan L Ogle Balance Due: 45.00
31647 1) 845.10 10/20/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Sherry M Rizkalla Balance Due: 45.00
31647 10/11/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Andrea Y Rubio Balance Due: �f 45.
Invoice 304125 (continued) page 2
Invoice 304125 Balance Due: 495.00
PLEASE REMIT PAYMENT PROMPTLY
o J 0
NOV 0 7 2011 u
J66 •eeneaeooe eaeaee.......
Purchase
Description
P.O.# PorF
G.L.
Budget
Line Descr
Purchaser Date
Approval Date
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
11/3/11 304125 Pre-employment drug testing 45.00
11/3/11 304125 Pre-employment drug testing 450.00
Total I 495.00
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
495.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE 1 109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1091 304125 4340700 45.00 1 hereby certify that the attached invoice(s), or
1081 -99 304125 4340700 450.00 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
17 -Nov 2011
—J A
Signature
495.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund