208250 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
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Line Uescr_
Mir; Purchas cJ 9 /IZ
Invoice Approva Date
April 03, 2012 108 7b(D
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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