174799 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $765.00
CARMEL, INDIANA 46032 P O BOX 19383
INDIANAPOLIS IN 46219 CHECK NUMBER: 174799
i CHECK DATE: 7/22/2009
DEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER AMOU D ESCRIPTION
1046 4340700 240041 765.00 MEDICAL FEES
Community Occupational Health Services
P.O. Box 19383
e eS l Indianapolis, IN 46219
Casaip4l'o!e C� �A� K q 317-355-6335
PD.0 pptp ko Tax ID 35- 1955223 JUN 1
ol�_ V3q 7 0v $y, Z 20 Q9
Budget vy I -e S
tJne .�.�n.
Invoice
June 03, 2009
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 5/09
1411 E. 116th St.
Carmel, IN 46032
Invoice 240041
Proc Code Service Date Description Quantity Charge Receipt Adjust Balance
80101 05/21/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Brandon P Brown Balance Due: 45.00
80101 05/23/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
William A Fama, Jr Balance Due: 45.00
80101 05/19/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Steven T Goedde Balance Due: 45.00
80101 05/14/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Melissa L Gordon Balance Due: 45.00
80101 05/18/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Anne N Hosek Balance Due: 45.00
86101 05/20/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
3;;
Heather Al Hudson Balance Due: 45.00
80 0 i 05/12/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Joseph J Kartholl Balance Due: 45.00
80101 05/07/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Moll- K ARGeehan Balance Due: 45.00
80101 05/17/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
S r
Birgitta R Monson Balance Due: 4
9O101 05/13/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
•a,
80 1
JUL U 2 2009
Invoice 240041 (continued) page 2
Richard B Nehring Balance Due: 45.00
J�1N ale G� ✓QY/
00 �3 un1\ QS 45 -0fl
80101 05/20/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 ON e�� °l�4 45.00
Cory A O'Cull Balance Due: i y5. 00
80101 05/19/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Devyn A Pauley Balance Due: 45.00
80101 05/18/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Eat; Lauren All Reising Balance Due: 45.00
80101 05/11/2009 Ding Screen Non NIDA 5 Panel 1.00 45.00 45.00
Tyler D Rosh Balance Due: 45.00
80101 05/21/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
David P Schnieders Balance Due: 45.00
r
96"
1 05/15/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Devyn R Tingley Balance Due: 45.00
I
80101 05/21/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Lauren Al Wright Balance Due: 45.00
Invoice 240041 Balance Due: 819.00
i vU
PLEASE REMIT PAYMENT PROMPTLY. THANK YOU
a)
3
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
Indianapolis, IN 46219
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/3/09 240041 Pre employment drug testing 765.00
Total 765.00
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
.r
765.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 240041 4340700 765.00 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
16 -Jul 2009
Signature
765.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund