209754 06/18/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CFfE�gER
CARMEL, INDIANA 46032 7169 SOLUTION CENTER K AMOUNT: $1,035.00
CHICAGO IL 60677 -7001
CHECK NUMBER: 209754
CHECK DATE: 6118/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 319991 135.00 MEDICAL FEES
1082 4340700 319991 900.00 MEDICAL FEES
Community Occupational Health Services
7169 Solution Center
Chicago, IL 60677 -7001
Phone: 317- 621 -0337
FEIN: 35- 1955223
Invoice
May 17, 2012
Bill to: Lynn Russell For: Cannel Clay Parks Recreation
Cannel Clay Parks Recreation 5 -12
1411 E. 116th St.
Carmel, IN 46032-
Invoic 319991
Proc Code Date Description Qtv Charge Recei t Adjust Balance
746404 05/08/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Eric J Abbenhaus Balance Due: 45.00
746404 05/07/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
David W Connors Balance Due: C- 45. 00
746404 05/07/2012 Drug Screen Non NIDA 5 Panel 1.00, 45.00 45.00
Lesley A Cox Balance Due: 45.00
746404 05/11/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 .45.00
Ryan P Duffy Balance Due: 45.00
746404 05/07/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Max C Ellis Balance Due: 45.00
746404 05/06/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 ri 45.00
Jill K Friedlin Balance Due: L 45.00
746404 05/01/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Amanda N Gillim Balance Due: 45.00
746404 05/05/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Richard G Henry Balance Due: 45.00
746404 05/08/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Olivia P Horton Balance Due: S 45.00
746404 05/10/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Cameron E Johnson Balance Due: v 45.00
746404 05/07/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
Amy M Kiray Balance Due: 45.00
746404 05/11/2012 Drug Screen Non NIDA 5 Panel 1.00 45.00 45.00
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
5/17/12 319991 Pre-employment diruq testing 135.00
5/17/12 319991. Pre-employment drug testing 900.00
Total 1,035.00
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
1,035.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -99 319991 4340700 135.00 1 hereby certify that the attached invoice(s), or
1082 -99 319991 4340700 900.00 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
14 -Jun 2012
Signature
1,035.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund