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Home My WebLink About211688 08/14/2012 „f CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $409.00 CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHICAGO IL 60677-7001 CHECK NUMBER: 211688 CHECK DATE: 8/14/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 326186 225 . 00 MEDICAL FEES 1082 4340700 326186 45 . 00 MEDICAL FEES 1091 4340700 326186 45 . 00 MEDICAL FEES 2201 4239099 326419 94 . 00 OTHER MISCELLANOUS Community Occupational Health Services 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0337 FEIN: 35-1955223 Invoice July 24, 2012 Bill to: Jim Spelbring For: Cannel Street Dept. Cannel Street Dept. 7/12 1 Civic Square Camiel, IN 46032- Invoice # 326419 Proc Code Date Description Qty Charge Receipt Adjust Balance 07/16/2012 Respirator Fit Test 1.00 47.00 47.00 Evie M Anderson XXX-XX-7323 Balance Due: 47.00 07/16/2012 Respirator Fit Test 1.00 47.00 47.00 Crystal E Edmondson XXX-XX-7882 Balance Due: 47.00 Invoice# 326419 Balance Due: 94.00 PLEASE REMIT PAYMENT PROMPTLY Cut and return with payment `- ---------------------------------------------------------------------------- Please remit 94.00 to Community Occupational Health Services 7169 Solution Center Please place invoice number 326419 on check Chicago,IL 60677-7001 Phone: 317-621-0337 VOUCHER NO. WARRANT NO. ALLOWED 20 Community Occupational Health Services IN SUM OF $ 7169 Solution Center Chicago, IL 60677-7001 $94.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 2201 1 326419 1 42-390.991 $94.00 1 hereby certify that the attached invoice(s), or 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 Tj u�sday ugust 09, 2012 Street Commissti ner Title Cost distribution ledger classification if claim paid motor 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 service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s)or bill(s)) 07/24/12 326419 $94.00 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 Community Occupational Health Services Purchase ',�n 1 7169 Solution Center Description _ Y V 1 Q �1�(JL �eS Chicago, IL 60677-7001 P.O.# P or F Phone: 317-621-0337 - - ----� FEIN: 35-1955223 i LuBd ��S I ne�e�,.cr se at al Date 7 tZ Invoice liqu V3 y U v rJ �S".v v July 24, 2012 /0 q1- y3 ya-7 oo - s. o 0 Bill to: Lynn Russell For: Cannel Clay Parks & Recreation Carmel Clay Parks & Recreation 7/12 1411 E. 116th St. Cannel, IN 46032- Invoice# 326186 Proc Code ICD9 Date Description Qty Charge Receipt Adiust Balance 746404 07/11/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Daniel J Drier Balance Due: (L 45.00 746404 07/11/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Whitney B Haas Balance Due: 45.00 746404 1)840.4 07/05/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 2) E925.8 Juan Mercado Balance Due: 45.00 746404 07/12/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Kylie K Montgomery Balance Due: S 45.00 746404 07/01/2012 Drug Scrcen-Non NIDA 5 Panel 1.00 45.00 45.00 Emily J Phillips Balance Due: 45.00 746404 07/19/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Sandra V Reay Balance Due: 45.00 746404 07/19/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Patricia A Simpson Balance Due: S 45.00 Invoice# 326186 Balance Due: 315.00 PLEASE REMIT PAYMENT PROMPTLY Cut and return with payment 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 7/24/12 326186 Pre-employment drug testing $ 225.00 7/24/12 326186 Pre-employment drug testing $ 45.00 7/24/12 326186 Pre-employment drug testing $ 45.00 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. I 355031 Community Occupational Health Services Allowed 20 7169 Solution Center Chicago, IL 60677-7001 In Sum of$ I $ 315.00 ON ACCOUNT OF APPROPRIATION FOR 108 - ESE 109- mot'w aegm2 PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1081-99 326186 4340700 $ 225.00 1 hereby certify that the attached invoice(s), or 1082-99 326186 4340700 $ 45.00 bill(s) is (are)true and correct and that the 1091 326186 4340700 $ 45.00 materials or services itemized thereon for which charge is made were ordered and received except 9-Aug 2012 Signature $ 315.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund