171799 04/29/2009 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $135.00
CARMEL, INDIANA 46032 P O BOX 19383 G
INDIANAPOLIS IN 46219 CHECK NUMBER: 171799
CHECK DATE: 4/2912009
DEPARTMENT ACCOUNT PO NUMBER INV OICE NUMBER AM DESCRIPTION
1046 4340700 236929 135.00 MEDICAL FEES
Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219 Purchase Indianapolis, r�s
317- 355 -6335 Description A ec i c p j
Yr Tax I D 35- 1955223 P.O. P or F
APR 0 6 2009 jlJ un'e -ee
Purchaser
BY:
Invoice
Approv Date
April 02, 2009
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Cannel Clay Parks Recreation 3/09
1411 E. 116th St.
Carmel, IN 46032-
Invoice 236929
ro Code Service Date Description Quantity Charge Receipt Adjust Balance
010 1 03/27/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 C i 45.00
c.r David M Plough Balance Due: 45.00
,0101 03/31/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 j 45.00
Patricia M Tyree Balance Due: 45.00
so101 03/20/2009 Dru g Screen Non NIDA 5 Panel 1.00 45.00 45.00
Bethany Wright Balance Due: 45.00
Invoice 236929 Balance Due: 135.00
THIS IS A REMINDER THAT NEW RATES WILL GO INTO EFFECT FOR
SERVICES RENDERED AFTER JANUARY 1,2009. FOR QUESTIONS, PLEASE
CONTACT YOUR ACCOUNT MANAGER. 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
Indianapolis, IN 46219
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
4/2/09 236929 Pre employment drug testing 135.00
Total 135.00
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$
135.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 236929 4340700 135.00 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 -Apr 2009
Signature
135.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund