178666 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH ggi�gg
INDIANA 46032 P O BOX 19383 CFIECK AMOUNT: $405.00
CARMEL
INDIANAPOLIS IN 46219
CHECK NUMBER: 178666
CHECK DATE: 10/28/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4340700 249342 405.00 MEDICAL FEES
-r
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
317- 355 -6335 OCT
Tax ID 35- 1955223 0 7 1009
Invoice
October 05, 2009
ill to: Lyme Russell For: Cannel Clay Parks Recreation
Carmel Clay Parks Recreation 9/09
1411 E. 116th St.
Cannel, IN 46032
Invoice 249342
Proc Code Date Description Qty Charge Receipr Adius Balance
80101 09/01/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Brittany A Hunt Balance Due: 45.00
80101 09/18/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
James M Laud Balance Due: 45.00
80101 09/18/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Rebecca L Marsh Balance Due: 45.00
80101 09/08/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Andrew Painchand Balance Due: 45.00
80101 09/16/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Diana Parr Balance Due: 45.00
80101 09/16/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Susan E Pendergrass Balance Due: 45.00
80101 09/01/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jenna Snellenberger Balance Due: 45.00
80101 09/14/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Ilandyia R Whitfield Balance Due: 45.00
80101 09/21/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Lyndsay M Zimmerman Balance Due: 45.00
i P.O. PorF
OCT 0 8 2009 aL# q q3q o7U0
t�,lru►deUe�..� ra 1�e P S �►u Tom)
oaa.acaasassaaaaa,v.oasa• P l�
APPICW4- 9
Invoice 249342 (continued) page 2
Invoice 249342 Balance Due: 405.00
PLEASE REMIT PAYMENT PROMPTLY. THANK YOU
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
t Indianapolis, IN 46219
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10/5/09 249342 Pre employment drug testing 405.00
Total 405.00
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
a
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
P.O. Box 19383
Indianapolis, IN 46219
In Sum of
405.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 249342 4340700 405.00 1 hereby certify that the attached invoice(s), or
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
22 -Oct 2009
Signature
405.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I