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Home My WebLink About212166 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ` ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH gEg�[ CARMEL, INDIANA 46032 7169 SOLUTION CENTER SACK AMOUNT: $270.00 CHICAGO IL 60677-7001 CHECK NUMBER: 212166 CHECK DATE: 8/28/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 327136 270 . 00 MEDICAL FEES Community Occupational Health Services 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0337 FEIN: 35-1955223 �f. T� 'F.T3 RE,__ . AUG 0 8 2012 Invoice —�- -- August 02, 2012 Bill to: Lynn Russell For: Cannel Clay Parks & Recreation Carmel Clay Parks & Recreation 7/12 1411 E. 116th St. Cannel, IN 46032- . _.... Invoice # 327136 Proc Code Date Description QQt V Charge Receipt Adiust Balance 746404 07/26/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Jehan Boles Balance Due: 45.00 746404 07/30/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Shannon Bulington Balance Due: 45.00 746404 07/27/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Michelle L Dean Balance Due: 45.00 746404 07/26/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Patricia A Sigh Balance Due: 45.00 746404 07/26/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Mollie E Whitmer Balance Due: 45.00 746404 07/31/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Lucy A Winter Balance Due: 45.00 q �J 1 Invoice# 327136 Balance Due: �� 270.00 Purchase o ► y/1 Q� f�N l�{ � Description 1 �� I.NVI v�� PLEASECREMIT PAYMENT PROMPTLY .L.# � I � --PF Budget l Line Descr tWO Purchase DatApproval DatZ 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 8/2/12 327136 Pre-employment drug testing $ 270.00 Total_L$ 270.00 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$ $ 270.00 ON ACCOUNT OF APPROPRIATION FOR 108 - ESE PO#or INVOICE NO. ACCT#fTITLE AMOUNT Board Members Dept# 1081-99 327136 4340700 $ 270.00 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 23-Aug 2012 Signature $ 270.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund