207009 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
j ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH SgE1�
CARMEL, INDIANA 46032 7169 SOLUTION CENTER M AMOUNT: $795.00
CHICAGO IL 60677 -7001 CHECK NUMBER: 207009
CHECK DATE: 3/13/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 312836 90.00 MEDICAL FEES
1081 434070.0 312878 585.00 MEDICAL FEES
1091 4340700 312878 45.00 MEDICAL FEES
1125 4340700 312878 75.00 MEDICAL FEES
Community Occupational Health Services
7169 Solution Center
Chicago, IL 60677 -7001
Phone: 317 -621 -0337
FEIN: 35- 1955223
0 5 2012
L
Invoice 07o
March 02, 2012
Bill to: Lynn Russell For: Carmel Clay Parks Recreation
Cannel Clay Parks Recreation 2/12
1411 E. 116th St.
Carmel, IN 46032-
Invoice 312836
Proc Code Date Description QtV Charge Receipt Adiust Balance
31647 02/01/2012 Drug Screen Non NI DA 5 Panel 1.00 45.00 45.00
Shelia L Brown Balance Due: 45.00
31647 02/09/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
v
Sarah Raigner Balance Due: 45.00
Invoice 312836 Balance Due: 9 0.00
PLEASE REMIT PAYMENT PROMPTLY
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Community Occupational Health Services
7169 Solution Center
Chicago, IL 60677 -7001
Phone: 317 -621 -0337
FEIN: 35- 1955223
l f R 0 5 2012
BT.
Invoice
March 02, 2012
Bill to: Lynn Russell For: Cannel Clay Parks Recreation
Carmel Clay Parks Recreation 2 -I2
1411 E. 1 16th St.
Carmel, IN 46032-
Invoice 312878
Proc Code Date Description QtV Charge Receipt Adiust Balance
31647 02/02/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Laura 3 Braun Balance Due: 1 45.00
31647 02/01/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
i
Anne ,r Doar Balance Due: 45.00
31647 02/08 /2012 Drug Screen Non NIDA 5 Pancl 1.00 45.00 45.00
Patrick C Gill Balance Due: 45.00
3 t647 02/29/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Mark. S Grainda Balance Due: L 45.00
31647 02/24/20 t2 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Nichole M ltaberlin Balance Due: V✓ti 4 5.00
31647 02/11/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Megan M Madison Balance Due: L 45.00
31647 02/01/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Alexander J Milborn Balance Due: tr 45.00
31647 02/11/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Manchion Neely Balance Due: i�-- 45.00
31647 02/11/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Jamaal M Nettles Balance Due: E7 4 5.00
31647 02/28/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Elaine M Russell Balance Due: 45.
31647 02/02/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Nancy L, Serowka Balance Due: L 45.
31647 02/01/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Invoice 312878 (continued) page 2
Brea J Simpson Balance Due: E 45.00
31647 02/06/2012 Drug Screen Non NiDA 5 Panel 1.00 45.00 45.00
82075 02/06/2012 Brcath Alcohol Test 1.00 30.00 30.00
Craig A Smith Balance Due: 75.00
31647 02/01/2012 Drug Screen Non N1 DA 5 Panel 1.00 45.00 45.00
Taylor Soultz Balance Due: r✓ 45.00
31647 02/09/2012 Drug Screcn Non NIDA 5 Panel 1.00 45.00 45.00
Meredith E Zimmerman Balance Due: Li i 4 5. 00
Invoice 312878 Balance Due: 705
PLEASE REMIT PAYMENT PROMPTLY
Purchase
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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
312112 312836 Pre-employment drug testing 90.00
312112 312878 Pre-employment drug testing 585.00
3!2112 312878 Pre-employment drug testing 45.00
312112 312878 Pre-employment drug testing 75.00
Total 795.00.
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
7169 Solution Center
Chicago, IL 60677 -7001
In Sum of
795.00
ON ACCOUNT OF APPROPRIATION FOR
101 General 1 108 ESE 1 109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -99 312836 4340700 90.00 1 hereby certify that the attached invoice(s), or
1081 -99 312878 4340700 58 5.00 bill(s) is (are) true and correct and that the
1091 312878 4340700 45.00 materials or services itemized thereon for
1125 312878 4340700 75.00 which charge is made were ordered and
received except
8 -Mar 2012
P
Signature
795.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund