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
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Community Occupational Health Services
P.O. Box 19383
Indianapolis, IN 46219
So a 317- 355 -6335
ne Tax ID 35- 1955223
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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