212550 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
` ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CFTE�ggEERR
CARMEL, INDIANA 46032 7169 SOLUTION CENTER K AMOUNT: $135.00
CHICAGO IL 60677-7001 CHECK NUMBER: 212550
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 328477 135 . 00 MEDICAL FEES
Community Occupational Health Services
7169 Solution Center
Chicago, IL 60677-7001 \
Phone: 317-621-0337 Purchase
CEIVED FEIN: 35-1955223 Description �� ��P S �ee�
P.O.# n p PatF
AUG �� 2012 G.L.# �}v-
Budget k)
Line Deser
$Y. Invoice Purchase 2_
August 16, 2012 Approval Dated/i
Z
Bill to: Lynn Russell For: Cannel Clay Parks & Recreation
Cannel Clay Parks & Recreation 8-12
1411 E. 116th St.
Cannel, IN 46032-
Invoice # 328477
Proc Code Date Description QQt V Charge Receipt Adjust Balance
746404 08/11/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Tinara L Davis Balance Due: 45.00
746404 08/09/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Joi-Lyn Thornton Balance Due: 45.00
746404 08/09/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Dallas Trottier Balance Due: 45.00
Invoice# 328477 Balance Due: 135.00
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
8/16/12 328477 Pre-employment drug testing $ 135.00
Total $ 135.00
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$
$ 135.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-99 328477 4340700 $ 135.00 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
6-Sep 2012
Signature
$ 135.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund