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Home My WebLink About209104 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH ggE�R CARMEL, INDIANA 46032 7169 SOLUTION CENTER M& AMOUNT: $463.00 CHICAGO IL 60677 -7001 CHECK NUMBER: 209104 CHECK DATE: 5/22/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 318623 148.00 OTHER EXPENSES 1081 4340700 318675 45.00 MEDICAL FEES 1082 4340700 318675 225.00 MEDICAL FEES 1125 4340700 318675 45.00 MEDICAL FEES Community Occupational Health Services 7169 Solution Center Chicago, IL 60677 -7001 Phone: 317- 621 -0337 MAY 2012 FEIN: 35- 1955223 BY: Invoice May 03, 2012 Bill to: Lynn Russell For: Carmel Clay Parks Recreation Cannel Clay Parks Recreation 4/12 1411 E. 116th St. Cannel, IN 46032- Invoice 318675 Proc Code ICD9 Date Description Qty Charge Receipt Adjust Balance 746404 04/29/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Matthew R Bickel Balance Due: 45.00 746404 1) 842.09 04/17/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 2) E927.0 Michele C Jones Balance Due: 45.00 746404 04/30/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Melissa R Lahti Balance Due: 45.00 746404 04/28/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Erin C Libby Balance Due: 45.00 746404 04/28/20 t 2 Drug Screen Non N I DA 5 Panel 1.00 45.00 45.00 Lauren M McRoberts Balance Due: 45.00 746404 04/19/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 q 45.00 Traci A Pettigrew Balance Due: i 45.00 746404 04/25/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00 Purchase 'n� Andrew C Servais Balance Due: Description -M y l t l�l alt fe e S 45.00 P.O. P or F Invoice 318675 Balance Due: 315.00 Budoet line Descr t 2S PLEASE REMIT PAYMENT PROMPTLY Purchaser, ate S Approval Date QS 0 0 0 V3 yO9oO �s 00 Cut and return with payment /of!- 9 Y-3 L1 o2 0 fi v( Please renal 315.00 to Community Occupational Health Services /O'F a 9 9 Y --3 Y b 7 Q b d o�S 0 7169 Solution Center Please place invoice number 318675 on chec lJ Chicago, IL 60677 -7001 Phone: 317 621 -0337 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 5012 318675 Pre employment drug testing 45.00 .5/3/12 318675 Pre-employment drug testing 45.00 5/3/12 318675 Pre employment drug testing 225.00 Total 315.00 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 315.00 ON ACCOUNT OF APPROPRIATION FOR 101 General 108 ESE PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members Dept 1125 318675 4340700 45.00 1 hereby certify that the attached invoice(s), or 1081 -99 318675 4340700 45.00 bill(s) is (are) true and correct and that the 1082 -99 318675 4340700 225.00 materials or services itemized thereon for which charge is made were ordered and received except 17 -May 2012 o^ Signature 315.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund Community Occupational Health Services 7169 Solution Center Chicago, IL 60677 -7001 Phone: 317- 621 -0337 FEIN: 35- 1955223 Invoice May 03, 2012 Bill to: Jim Spelbring For: Carmel Utilities Cannel Utilities 4/12 1 Civic Square Cannel, IN 46032- Invoice 318623 Proc Code Date Description QtV Charge Receipt Adjust Balance 04/12/2012 Whisper Test 1.00 7.00 7.00 81002 04/12/2012 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00 99173 04/12/2012 Snellen 1.00 7.00 7.00 99386 04/12/2012 DOT /PPCL Exam 1.00 53.00 53.00 Jeffery Cooper XXX -XX -7615 Balance Due: 74.00 04/30/2012 Whisper Test 1.00 7.00 7.00 81002 04/30/2012 Urinalysis, Mini Dip w/ Physical 1.00 7.00 7.00 99173 04/30/2012 Snellen 1.00 7.00 7.00 99386 04/30/2012 DOT /PPCL Exam 1.00 53.00 53.00 Robbie L Kinkead XXX -XX -4535 Balance Due: 74.00 Invoice 318623 Balance Due: 148.00 PLEASE REMIT PAYMENT PROMPTLY Cut and return with payment Please remit 148.00 to Community Occupational Health Services 7169 Solution Center Please place invoice number 318623 on check Chicago, 1L 60677 -7001 Phone: 317- 621 -0337 VOUCHER 117309 WARRANT ALLOWED 355031 IN SUM OF COMMUNITY OCCUPATIONAL HEALTI P 9 83 716 1 5oIut 't C 6 c Ago :T 007 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 318623 01- 7042 -06 $148.00 Voucher Total $148.00 Cost distribution ledger classification if claim paid under vehicle highway fund 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 5/14/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/14/2012 318623 $148.00 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 Officer