169399 03/04/2009 CITY OF CARMEL, INDIANA VENDOR: 355031 P892 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH S�g�[
CARMEL, INDIANA 46032 P O BOX 19383 GHECK AMOUNT: $619.00
INDIANAPOLIS IN 46219 CHECK NUMBER: 169399
CHECK DATE: 3/4/2009
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4340700 231178 499.00 MEDICAL FEES
1047 4340700 231178 120.00 MEDICAL FEES
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Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219 purchase
317- 355 -6335 Description Dru
t Tax ID 35- 1955223 p,Q, 0 porF
4aQ.00 0.L# xxx- 3 b
Bud et
purcha Date l
Invoice Approv Date
February 03, 2009
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 1/09
1411 E. 1 16th St.
Carmel, IN 46032-
Invoice 231178
Fi roc Cede Service Date Description Quantity Charcie Recei t Adiusi Balance
7 1 0101 01/30/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Kalita L Acosta Balance Due: 45.00
30101 01/10/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Aonya Anderson Balance Due: 4
:•0101 01/05/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jessica Ballinger Balance Due: 45.00
0100 01/08/2009 Drug Screen Rapid 5 Panel 1.00 49.00 49.00
India M Bond Balance Due: 49.00
;101 01/14/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Ashley Corn Balance Due: 45.00
<0101 01/07/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Ashley E Dennis Balance Due: 45.00
::0101 01/14/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
James Dowell Balance Due: 45.00
40101 01/10/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Michael J Drummy Balance Due: 45.00
8 01 01/14/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Stacey Griffith Balance Due: 4 5.00
t101 01/21/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
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Invoice 231178 (continued) page 2
Walker F Hinkle Balance Due: 45.00
0 01/03/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Audrey Hughey Balance Due: 45.00
'0101 01/21/2009 Ding Screen Non NIDA 5 Panel 1.00 45.00 45.00
,M75 01/21/2009 Breath Alcohol Test 1.00 30.00 30.00
Katie A Schneider Balance Due: 75.00
;0101 01/08/2009 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Deneyse Solazzo Balance Due: 45.00
Invoice 231178 Balance Due: 619.00
THIS IS A REMINDER THAT NEW RATES WILL GO INTO EFFECT FOR
SERVICES RENDERED AF TER JANUARY 1,2009. FOR QUESTIONS, PLEASE
CONTACT YOUR ACCOUNT MANAGER. THANK YOU
Cut and return with payment
Please remit 619.00 to Community Occupational Health Services
Please place invoice number 231178 on check P.O. Box 19383
Indianapolis, IN 46219
Phone: 317- 355 -6335
ACCOUNTS PAYABLE VOUCHER
•I 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)) Amount
2/3109 231178 Pre employment drug testing 499.00
2/3/09 231178 Pre employment drug testing 120.00
Total 619.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
P.O. Box 19383
Indianapolis, IN 46219
In Sum of
619.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 231178 4340700 499.00 1 hereby certify that the attached invoice(s), or
1047 231178 4340700 120.00 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
26 -Feb 2009
Signature
619.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund