206190 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $585.00
,o CARMEL, INDIANA 46032 7169 SOLUTION CENTER
CHICAGO IL 60677 -7001 CHECK NUMBER: 206190
CHECK DATE: 2/1412012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 309476 225.00 MEDICAL FEES
1091 4340700 309476 45.00 MEDICAL FEES
1081 4340700 310747 315.00 MEDICAL FEES
Community Occupational Health Services
7169 Solution Center
Chicago, IL 60677 -7001 W
Phone: 317- 621 -0337
FEIN: 35- 1955223 feioTC
JAN 9 1012
Invoice
January 04, 2012
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreatioll 12/11
1411 E. 116th St.
Carmel, IN 46032-
Invoice 309476
Proc Code ICD9 Date Description QtV Charge Receipt Adiust Balance
31647 1) 944.12 12/30/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
2) E924.8
Charles Binion Balance Due: 45.00
31647 12/28/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Songwah T Ly Balance Due: 45.00
31647 12/29/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Matthew L Meisenhelder Balance Due: 45.00
31647 12/14/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Cory A O'Cull Balance Due: 45.00
31647 12/14/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Andrew J Riley Balance Due: 45.00
31647 12/29/2011 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Haley M Spenard Balance Due: 45.00
'urchase r
)escription IV h��� ree S Invoice 309476 Balance Due: 270.00
1 .0. P or F PLEASE REMIT PAYMENT PROMPTLY
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Cut and return with payment
Please remit 270.00 to Community Occupational Health Services
7169 Solution Center
Please place invoice number 309476 on check Chicago, IL 60677 -7001
Phone: 317- 621 -0337
Community Occupational Health Services
7169 Solution Center
Chicago, IL 60677 -7001 F urch2�9 PS TS
Phone: 317- 621 -0337
o T� FEIN: 35- 1955223
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Purchaser Date
BY Invoice ,wl.1_ D
February 02, 2012
to: Lynn Russell For: Carmel Clay Parks Recreation
Carmel Clay Parks Recreation 1/12
1411 E. 116th St.
Carmel, IN 46032-
Invoice 310747
Proc Code ICD9 Date Description QtV Charge Recei t Adiust Balance
31647 01/26/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Kneosha S Davis Balance Due: 45.00
31647 01/04/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Patrick C Gill Balance Due: 45.00
31647 1) 923.3 01/17/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
2) E918
Ashley A Livingston Balance Due: 45.00
31647 01/27/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Cherrie A Palmer Balance Due: 45.00
31647 01/26/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Caitlin A Rhodes Balance Due: 45.00
1647 01/26/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
i1 Sadek Balance Due: 41.00
647 01/26/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Gail C Strong Balance Due: 45.00
Invoice 310747 Balance Due: 315.00
PLEASE REMIT PAYMENT PROMPTLY
Cut ana return \N;A 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
7169 Solution Center
Chicago, IL 60677 -7001
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1/4/12 309476 Pre-employment drug testing 225.00
1/4/12 309476 Pre-employment drug testing 45.00
212112 310747 Pre employment drug testing 315.00
Total 585.00
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
7169 Solution Center
Chicago, IL 60677 -7001
In Sum of
r1PFa.0 CsS
585.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE 109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -99 309476 4340700 225.00 1 hereby certify that the attached invoice(s), or
1091 309476 4340700 45.00 bill(s) is (are) true and correct and that the
1081 -99 310747 4340700 315.00 materials or services itemized thereon for
which charge is made were ordered and
received except
9 -Feb 2012
Signature
585.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund