177616 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $1,080.00
CARMEL, INDIANA 46032 P O BOX 19383
9y INDIANAPOLIS IN 46219
CHECK NUMBER: 177616
CHECK DATE: 9/29/2009
DE PARTMENT ACCOUN PO NU MBER INVOICE NUMBER AM DESCRIPTION
1046 4340700 246652 1,080.00 MEDICAL FEES
Community Occupational Health Services
y P.O. Box 19383
Indianapolis, IN 46219
317- 355 -6335 Ti� D
Tax ID 35- 1955223
S E P 0 8 2009
BA Y.
Invoice
September 03, 2009
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 8/09
1411 E. 1 16th St.
Carmel, IN 46032-
Invoice 246652
Proc Code Service Date Description Quantity Charge Receipi Adjust balance
80101 08/26/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Elizabeth M Anderson Balance Due: 45.00
------------------------------------I-----------------------------------------
80101 08/28/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Shauna D Anderson Balance Due: 45.00
80101 08/07/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Eboni N Andrews Balance Due: 45.00
80101 08/14/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Sierra M Ayres Balance Due: 45.00
80101 08/25/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Kathleen Berbari Balance Due: 45.00
80101 08/14/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jessica E Bowman Balance Due: 45.00
80101 08/13/2009 DruH Screen Non NIDA 5 Panel 1.00 45.00 45.00
Katey A Buennagel Balance Due: 45.00
80101 08/07/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
China L Burr Balance Due: 45.00
80101 08/18/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Sadie Cebada Balance Due: 45.00
80101 08/28/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
De chars tt L N W ITeSA)
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o.�� 00 --90o y 3 V 0700
Budget
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Purchases 109
APP►
r' Invoice 246652 (continued) page 2
Misti A Gardiner Balance Due: 45.00
80101 08/01/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Kendra L Gladney Balance Due: 45.00
80101 08/01/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Brittany E Green Balance Due: 45.00
80101 08/28/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Kevin D Jackson Balance Due: 45.00
80101 08/06/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Kevin M Kerswick Balance Due: 45.00
80101 08/18/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Nicole Nl Kraus Balance Due: 45.00
80101 08/27/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Angela M Mitchell Balance Due: 45.00
80101 08/19/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jonna N Nance Balance Due: 45.00
80101 08/28/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Joshua R O'Brien Balance Due: 45.00
80101 08/05/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Joshua W Reeves Balance Due: 45.00
80101 08/13/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Julie A Reindle Balance Due: 45.00
80101 08/05/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jessica R Richards Balance Due: 45.00
80 i 01 08/08/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Amany R Sadek Balance Due: 45.00
80101 08/19/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Douglas L Snelling Balance Due: 45.00
80101 08/04/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Emily M Stowell Balance Due: 45.00
Invoice 246652 (continued p age 3
w R
Invoice 246652 Balance Due: 1080.00
PLEASE REMIT PAYMENT PROMPTLY. THANK YOU
r Cut and return with payment
Please remit 1,080.00 to Community Occupational Health Services
Please place invoice number 246652 on check P.O. Box 19383
Indianapolis, IN 46219
Phone: 317 355 -6335
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
913109 246652 Pre employment drug testing 1,080.00
Total 1,080.00
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$
1,080.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program fund
PO# or INVOICE NO. ACCT #fTITLE AMOUNT Board Members
Dept
1046 246652 4340700 1,080.00 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
24 -Sep 2009
Signature
1,080.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund