HomeMy WebLinkAbout211254 07/31/2012 ,,- CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
f, ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $405.00
?o CARMEL, INDIANA 46032 7169 SOLUTION CENTER
o� CHICAGO IL 60677-7001 CHECK NUMBER: 211254
CHECK DATE: 7131/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 323765 135 . 00 MEDICAL FEES
1082 4340700 323765 270 . 00 MEDICAL FEES
Community Occupational Health Services
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0337
FEIN: 35-1955223 7BY:-.
F'��� " D,
06 2012
Invoice
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July 03, 2012
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Cannel Clay Parks & Recreation 6/12
1411 E. 1 16th St.
Cannel, IN 46032-
Invoice # 323765
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Proc Code Date Description Qty_ Charge Receipt Adjust B I lance
746404 06/28/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Erin J Baird Balance Due: 145.00
746404 06/25/2012 Drug Screen- Non NIDA 5 Panel 1.00 45.00 1145.00
Sarah C Fitch Balance Due: C- 145.00
746404 06/29/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 145.00
Kaylee R Good Balance Due: S X45.00
746404 06/15/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 145.00
Stephanie M Lukas Balance Due: 45.00
746404 06/14/2012 Drug Screen-Non N I DA 5 Panel 1.00 45400 4500
Brendon C McAvoy Balance Due: 45.00
746404 06/28/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 4500
Zachary Peterman Balance Due: 1 45.00
746404 06/28/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 1 45.00
Mariam M Saeedi Balance Due: S 1 45.00
746404 06/29/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
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Danielle M Vercesi Balance Due: Q 145.00
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746404 06/14/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
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Selah G Yang Balance Due: � 45.00
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Purchase
Description S Invoice# 323765 Balance Due: 405.00
P.O.# P or F
PLEASE REMIT PAYMENT PROMPTLY
Line-b D 9 /L�1
Line Desc J
Budoe
Purchaser to l Z
Approval Date
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ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL I
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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.
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355031 Community Occupational Health Services Terms i
7169 Solution Center
Chicago, IL 60677-7001
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Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
7/3/12 323765 Pre-employment drug testing $ 135'.00
7/3/12 323765 Pre-employment drug testing $ 2701.00
Total $ 405.00
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_ I
Clerk-Treasurer
Voucher No. Warrant No.
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
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$ 405.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-99 323765 4340700 $ 135.00 1 hereby certify that the attached invoice(s), or
1082-99 323765 4340700 $ 270.00 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
26-Jul 2012
p Y2&�-j
Signature
$ 405.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund