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Home My WebLink About208250 04/25/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH URK AMOUNT: $569.00 CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHICAGO IL 60677 -7001 CHECK NUMBER: 208250 CHECK DATE: 4/25/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 315534 405.00 MEDICAL FEES 1091 4340700 315534 45.00 MEDICAL FEES 1125 4340700 315534 45.00 MEDICAL FEES 651 5023990 315777 74.00 OTHER EXPENSES Community Occupational Health Services 7169 Solution Center Chicago, IL 60677 -7001 Purchase J �p Phone: 317 621 -0337 1sc ription �2 L �IPSfS D 1J FEIN: 35- 1955223 P.O. P or F APR U a 2012 dget gi ldaet Line Uescr_ Mir; Purchas cJ 9 /IZ Invoice Approva Date April 03, 2012 108 7b(D A p lo91 `}3y b7o� A S. 00 ZS- Y1* 3 `f O 7 4 Bill to: Lynn Russell For: Cannel Clay Parks l Recreation Cannel Clay Parks Recreation 3/12 1411 E. 116th St. Cannel, IN 46032- hlvoice 315534 Proc Code ICD9 Date Description QQt V Charqe Recei t Adjust Balance 31647 03/09/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Joseph C Broman Balance Due: 45.00 31647 03/09/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 John O Gates Balance Due: 4 5.00 31647 03/26/2012 Drug Screen Non NIDA 5 Pancl 1.00 45.00 45.00 Mary Habig Balance Due: 45.00 31647 03/28/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Dhanya Kalliparambil Balance Due: 4 5.00 31647 03/12/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Josliva T Knox Balance Due: 45.00 31647 03/26/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Zachary T Kogler Balance Due: 45.00 31647 03/27/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Dominic G LaRondie Balance Due: 45.00 31647 1) 923.10 03/22/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 2) E968.8 Sarah Raigner Balance Due: 45.00 31647 03/26/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Morsal Rasouli Balance Due: 45.00 31647 03/26/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Tiffany Swanson Balance Due: 4 5.0 0 31647 03/10/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Heather L VanAsten Balance Due: 45.00 Invoice 315534 (continued) page 2 Invoice 315534 Balance Due: 495.00 PLEASE REMIT PAYMENT PROMPTLY Cut and retum with 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 4/3112 315534 Pre-employment drug testing 405.00 4/3/12 315534 Pre-employment drug testing 45.00 4/3/12 315534 Pre-employment drug testing 45.00 Total 495.00 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 495.00 ON ACCOUNT OF APPROPRIATION FOR 101 General 108 ESE 109 Monon Center PO# or INVOICE NO. ACCT #fTITLE AMOUNT Board Members Dept 1081 -99 315534 4340700 .405.00 1 hereby certify that the attached invoice(s), or 1091 315534 4340700 45.00 bill(s) is (are) true and correct and that the 1125 315534 4340700 45.00 materials or services itemized thereon for which charge is made were ordered and received except 19 -Apr 2012 Signature 495.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund r 1 Community Occupational Health Services 7169 Solution Center Chicago, IL 60677 -7001 Phone: 317 621 -0337 IZ�1 FEIN: 35- 1955223 Invoice April 03, 2012 Bill to: Jim Spelbring For: Carmel Utilities Cannel Utilities 3/12 1 Civic Square Cannel, IN 46032- Invoice 315777 Proc Code Date Description Qty Charge Receipt Adjust Balance 03 /t 3/2012 Whisper Test 1.00 7.00 7.00 51002 03/13/2012 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00 99173 03/13/2012 Snellen 1.00 7.00 7.00 99336 03/13/2012 DOT /PPCL Exam 1.00 53.00 53.00 Eric S Robinson XXX -XX -7938 Balance Due: 74.00 Invoice 315777 Balance Due: 74.00 PLEASE REMIT PAYMENT PROMPTLY D n APR 09 2012 By Cut and retum with payment Prescribed by State Board of Accounts City Form No. 201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 355031 COMMUNITY OCCUPATIONAL HEALTH Purchase Order No. PO BOX 19383 Terms INDIANAPOLIS, IN 46219 Due Date 4/17/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 4/17/2012 315777 $74.00 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 Date gicer VOUCHER 117168 WARRANT ALLOWED 355031 IN SUM OF COMMUNITY OCCUPATIONAL HEALTI pe-B�sue- l 5 v P4 j L nZtt �)t6, o I L- Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 315777 01- 7042 -06 $74.00 Voucher Total $74.00 Cost distribution ledger classification if claim paid under vehicle highway fund