HomeMy WebLinkAbout176714 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $1,215.00
CARMEL, INDIANA 46032 P 0 BOX 19383
INDIANAPOLIS IN 46219
CHECK NUMBER: 176714
CHECK DATE: 9/2/2009
DEPARTMEN ACCOU PO NUMBER INVOICE NUMBER AMO DE SCRIPTION
.1046 4340700 245075 1,080.00 MEDICAL FEES
1125 4340700 245075 135.00 MEDICAL FEES
it
Invoice 245075 (continued) page 3 b pq
AU Rebecca R Thompson Balance Due: 45.00
80101 IR l v 07/17/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Haley Wildrick Balance Due: 45.00
I
0101 07/21/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Sireen A Zayed Balance Due: 45.00
Invoice 245075 Balance Due: 1215.00
PLEASE REMIT PAYMENT PROMPTLY. THANK YOU
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Cut and return with payment
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
317- 355 -6335
Tax ID 35- 1955223
406 1 0
100
Invoice
August 04, 2009
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 7 -09
1411 E. 116th St.
Carmel, IN 46032-
Invoice 245075
Proc Code Service Date Description Quantit Charge Receipt Adiust Balance
80101 07/15/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Sylvia L Andrews Balance Due: 45.00
80101 07/24/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 J 1 45.00
Helen I Ballinger Balance Due: 45.00
80101 07/23/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jessica D Balowski Balance Due: 45.00
80101 07/16/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Kianna N Bibler Balance Due: 45.00
80101 07/16/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
LaChristian C Brown Balance Due: 45.00
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80101 07/15/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Keysha L Cooper Balance Due: 45.00
80101 07/21/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Joshua D Harrell Balance Due: 45.00
80101 07/28/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Sharmesha J Jackson Balance Due: 45.00
80101 07/16/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Ofelia Jaimes Balance Due: 45.00
80101 07/31/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Invoice 245075 (continued) page 2��
Karl Jon is BaQeepw: 45.00
g 0
80101 07/29/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 9 45.00
Stephen L Jones Balance Due: 45.00
86101 07/21/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Kandeh Kamara Balance Due: 45.00
80101 07/28/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Leslie E Kesler Balance Due: 45.00
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80101 07/24/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 kok 45.00
Jeffrey P Kramer Balance Due: 45.00
80101 07/16/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
David C LaFollette Balance Due: 45.00
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80101 07/28/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Eric J Madden Balance Due: 45.00
80101 07/16/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Lance B Marbley Balance Due: 45.00
80101 07/22/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Christina M O'Connor Balance Due: 45.00
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80101 07/21/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Kayla M Phillips Balance Due: 45.00
80101 07/22/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Katelyn R Ray Balance Due: 45.00
80101 07/22/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Anita G Rodriquez Balance Due: 45.00
80101 07/16/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Savannah Rose Balance Due: 45.00
80101 07/17/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
George H Ruiz -Gill Balance Due: 45.00
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80101 07/16/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Carol E Shinn Balance Due: 45.00
80101 07/16/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
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
8/4/09 245075 Pre employment drug testing 1,080.00
8/4/09 245075 Pre employment drug testing 135.00
Total 1,215.00
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$
4
1,215.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund 104 Program fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 245075 4340700 1,080.00 1 hereby certify that the attached invoice(s), or
1125 245075 4340700 135.00 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
27 -Aug 2009
Signature
1,215.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
1