176189 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH ggEERR�[
4 0 CHECK AMOUNT: $122.00
CARMEL, INDIANA 46032 P O BOX 19383
`o INDIANAPOLIS IN 46219 CHECK NUMBER: 176189
CHECK DATE: 8/1912009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUM A MOUNT DESCRIP
651 5023990 245260 122.00 OTHER EXPENSES
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Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
317- 355 -6335
Tax ID 35- 1955223
Invoice
August 04, 2009
Bill to: Shelly Lingelbaugh For: Carmel Utilities
Carmel Utilities July 2009
1 Civic Square
Carmel, IN 46032-
Invoice 245260
Proc Code Service Date Description Quantity Charge Receipt Adiust Baiance
07/09/2009 Whisper Test 1.00 7.00 7.00
31655 07/09/2009 Drug Screen NIDA 5 1.00 48.00 48.00
81002 07/09/2009 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00
99173 07/09/2009 Snellen 1.00 7.00 7.00
99386 07/09/2009 DOT/PPCL Exam 1.00 53.00 53.00
David L Turner XXX -XX -2951 Balance Due: 122.00
Invoice 245260 Balance Due: 122.00
PLEASE REMIT PAYMENT PROMPTLY. THANK YOU
ilio
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL r
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
355031
COMMUNITY OCCUPATIONAL HEALTH Purchase Order No.
PO BOX 19383 Terms 1�
INDIANAPOLIS, IN 46219 Due Date 8/11/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/11/2009 245260 $122.00
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hereby certify that the attached invoice(s), or bill(s) is (are) true and
;orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
31�V—
Date Officer
VOUCHER 096212 WARRANT ALLOWED
355031 IN SUM OF
COMMUNITY OCCUPATIONAL HEALTI
PO BOX 19383
INDIANAPOLIS, IN 46219
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
245260 01- 7362 -05 $122.00
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I
Voucher Total $122.00
Cost distribution ledger classification if
claim paid under vehicle highway fund