210797 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH SE��[
o CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK AMOUNT: $463.00
CHICAGO IL 60677-7001 CHECK NUMBER: 210797
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4340700 322765 225 . 00 MEDICAL FEES
1091 4340700 322765 45 . 00 MEDICAL FEES
1125 4340700 322765 45 . 00 MEDICAL FEES
651 5023990 323956 74 . 00 OTHER EXPENSES
651 5023990 324328 74 . 00 OTHER EXPENSES
W-9H3:.,:
Pu -hase Community Occupational Health Services
Descr tion 7169 Solution Center
P.O.# PorF Chicago, IL 60677-7001
\ / Phone: 317-621-0337
G.L.# FEIN: 35-1955223 =BY:
Budget
Line Descr
Purchaser Date
Approval Da et
Invoice
June 18, 2012
Bill to: Lynn Russell For: Cannel Clay Parks & Recreation
Carmel Clay Parks & Recreation 6/12
1411 E. 116th St.
Cannel, IN 46032-
Invoice # 322765
Proc Code ICD9 Date Description QtV Charge Recei t Adiust Balance
746404 06/08/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Jacob Backes Balance Due: C- 45.00
746404 06/05/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Tolulope Falodun Balance Due: 45.00
746404 1)993.0 06/05/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
2)389.9
Emily E Hollinberger Balance Due: 45.00
746404 06/07/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Mercedes N Martin Balance Due: L 45.00
746404 06/02/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
((Z
Megan Omalley Balance Due: 45.00
746404 1)840.9 06/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
2)E927.0
Craig A Smith Balance Due: 45.00
746rehase I n �J 6 05/20112 rug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Description �l.l�W (� ( �P P_
P.O.# PorF Dean Weaver Balance Due: G 45.00
.L.#
Budget
Line Descr �19,1('171� S �� SI ��'�s Invoice# 322765 Balance Due: 315.00
(�Z`6 I Z
Purchaser e-='- LEASE REMIT PAYMENT PROMPTLY
Approval Date L o-t
�/ / P- 000 - c/3gO7OU -- }�3 op
113V 0-7 00 . - -'9- ys�a
/ 09a - ? 9 - V3/070 () aaS o
�. Cut and return with payment b
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
6/18/12 322765 Pre-employment drug testing $ 45.00
6/18/12 322765 Pre-employment drug testing $ 45.00
6/18/12 322765 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/ 109 Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 322765 4340700 $ 45.00 1 hereby certify that the attached invoice(s), or
1091 322765 4340700 $ 45.00 . bill(s) is(are)true and correct and that the
1082-99 322765 4340700 $ 225.00 materials or services itemized thereon for
which charge is made were ordered and
received except
12-Jul 2012
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
July 03, 2012
Bill to: Jim Spelbring For: Carmel Utilities
Cannel Utilities 6/12
1 Civic Square
Cannel, IN 46032-
Invoice # 324328
Proc Code Date Description Qty Charge Receipt Adjust Balance
06/21/2012 Whisper Test 1.00 7.00 7.00
81002 06/21/2012 Urinalysis,Mini Dip w/Physical 1.00 7.00 7.00
99173 06/21/2012 Suellen 1.00 7.00 7.00
99386 06/21/2012 DOT/PPCL Exam 1.00 53.00 53.00
Michael B Turner XXX-XX-1578 Balance Due: 74.00
Invoice# 324328 Balance Due: 74.00
PLEASE REMIT PAYMENT PROMPTLY
o� Cut and return with payment
- ---------------------------------------------------------------------------
Please remit 74.00 to Community Occupational Health Services
7169 Solution Center
Please place invoice number 324328 on check Chicago,IL 60677-7001
Phone: 317-621-0337
Comm Occup Hlth Svcs Carmel
11911 N. Meridian St., Ste.160
Carmel, IN 46032
Phone: 317-621-6704
FEIN: 35-1955223
Invoice
Bill to: Jim Spelbring For: Cannel Utilities
Cannel Utilities
1 Civic Square
Carmel, IN 46032-
_._.. .
..........._...._.__._........._._—.. ...._...... _. _.. _ . . .._.. .
Invoice # 323956
Proc Code Date Description Qty_ Charge Receipt Adjust Balance
05/23/2012 Whisper Test 1.00 7.00 7.00
81002 05/23/2012 Urinalysis,Mini Dip w/Physical 1.00 7.00 7.00
99173 05/23/2012 Snellen 1.00 7.00 7.00
99386 05/23/2012 DOT/PPCL Exam 1.00 53.00 53.00
Harold B Oliver XXX-XX-5008 Balance Due: 74.00
Invoice# 323956 Balance Due: 74.00
PLEASE REMIT PAYMENT PROMPTLY
o, Cut and return with payment
cY -- --------------------------------------------- -- --
Please remit 74.00 to Community Occupational Health Svs
7169 Solution Center
Please place invoice number 323956 on check Chicago, IL 60677-7001
Phone: 317-621-0337
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 7/9/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/9/2012 323956 $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
7//3�/t, 1h.
Date Officer
VOUCHER # 125272 WARRANT # ALLOWED
355031 IN SUM OF $
COMMUNITY OCCUPATIONAL HEALTI
PO BOX 19383
INDIANAPOLIS, IN 46219
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
323956 01-7042-06 $74.00
7 Y, 00
Voucher Total $7
Cost distribution ledger classification if
claim paid under vehicle highway fund