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Home My WebLink About210797 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