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HomeMy WebLinkAbout204752 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $225.00 CARMEL, INDIANA 46032 P 0 BOX 19383 INDIANAPOLIS IN 46219 �o CHECK NUMBER: 204752 CHECK DATE: 12/20/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 306277 135.00 MEDICAL FEES 1081 4340700 308299 45.00 MEDICAL FEES 1091 4340700 308299 45.00 MEDICAL FEES Community Occupational Health Services P.O. Box 19383 Indianapolis, IN 46219 Phone: 317-355-6335 FEIN: 35-1955223 Invoice December 02, 2011 Bill to: Lynn Russell For: Carmel Clay Parks Recreation Carl Clay Parks Recreation 11 /1 1 141 E. 1 16th St. Carmel, TN 46032- Invoice 308299 Proc Code ICD9 Date Description Qty Charge Receip Balance 31647 1)844,9 11/30/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 2) E927.0 Alicia M Commons Balance Due: 45.00 31647 11/30/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Kristen M Osburn Balance Due: 45.00 Invoice 308299 Balance Due: 90.00 PLEASE REMIT PAYMENT PROMPTLY Purchase IA orl;0(11 I1VU3 Tf4b Description P P.O. orF Budget Line Descr u n 'ge� -Wa )E'cr et W a Purchaser a'_ CApproval Date- 101 �r9 0 0 OD L/ V 0 D v DEC 08 2011 Cut and return with payment Community Occupational Health Services P.O. Box 19383 Indianapolis, IN 46219 Phone: 317- 355 -6335 FEIN: 35- 1955223 Invoice November 30, 2011 Bill to: Lynn Russell For: Cannel Clay Parks Recreation Cannel Clay Parks Recreation 1411 E. 116th St. Cannel, IN 46032- Invoice 306277 Proc Code Date Description Qty Charge Receipt Adlust Balance 31647 1 1/02/201 1 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Leonid Melnikov Balance Due: 4 5.00 31647 t 1/09/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 John D Oliver Balance Due: 45.00 31647 11/16/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Juan M Sanchez Coyt Balance Due: 5� 45.00 Invoice 306277 Balance Due: 135.00 PLEASE REMIT PAYMENT PROMPTLY DEC 0 2011 Purchase J ,`(J (1 1 /Q/J CD 'f Lob) Description P.Q. P or P a� G.L. r��'� Budget lJ►'u f Line Descr I f Purchaser ate r Approval Date Cut and retum 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 1212111 308299 Pre-employment drug testing 45.00 1212111 308299 Pre-employment drug testing 45.00 11/30/11 306277 Pre-employment drug testing 135.00 Total 225.00 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 225.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE 1 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1081 -99 308299 4340700 45.00 1 hereby certify that the attached invoice(s), or 1091 308299 4340700 45.00 bill(s) is (are) true and correct and that the 1081 -99 306277 4340700 135.00 materials or services itemized thereon for which charge is made were ordered and received except 15 -Dec 2011 Signature 225.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund