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HomeMy WebLinkAbout167953 01/21/2009 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH ggEE�� CARMEL, INDIANA 46032 P 0 BOX 19383 CHECK AMOUNT: $344.00 INDIANAPOLIS IN 46219 o CHECK NUMBER: 167953 CHECK DATE: 1/21/2009 DEPARTMEN ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1046 4340700 227266 344.b0 MEDICAL FEES r Community Occupational Health Services P.O. Box 19383 Indianapolis, IN 46219 So a 317- 355 -6335 ne Tax ID 35- 1955223 nh� load Invoice December 03, 2008 Bill to: Lynn Russell For: Carmel Clay Parks Recreation Carmel Clay Parks Recreation 11/08 1411 E. 116th St. Cannel, IN 46032- Invoice 227266 Proc Code Service Date Description Quantity Charge Receipt Adjust Balance 80101 11/07/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00 Dawn M Armbruster Balance Due: 4 3.00 80101 11/06/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00 Belinda Day Balance Due: 43.00 80101 11/07/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00 Jill K Friedlin Balance Due: 43.00 80101 11/18/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00 Urcelina M Jenkins Balance Due: 43.00 80101 11/24/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00 DeAndre Mays Balance Due: 43.00 80101 11/07/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00 Aaron N Smith Balance Due: 43.00 80101 11/06/2008 Drug Screen Non NIDA 5 Panei 1.00 43.00 4 3. 0 Zackery Tyler Balance Due: 43.00 80101 11/05/2008 Drug Screen Non NIDA 5 Panel 1.00 43.00 43.00 James A Whiteley Balance Due: 43.00 Invoice 227266 Balance Due: 344.00 PLEASE REMIT PAYMENT PROMPTLY rt Y Cut and return with payment ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice.of bilf:;� be properly itemized must show; kind of service, where performed, dates service rendered, by whom, rags 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)) iii j Amount 1213/08 227266 Pre employment drug testing 4.00 Total 344.00 I 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 344.00 ON ACCOUNT OF APPROPRIATION FOR 104 Program fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1046 227266 4340700 344.00 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 12 -Jan 2009 W l, Signature 344.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund