212166 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
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Description 1 �� I.NVI v�� PLEASECREMIT PAYMENT PROMPTLY
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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