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
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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
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Approval Date
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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