HomeMy WebLinkAbout212966 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
0 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH gEg�[
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK AMOUNT: $574.00
CHICAGO IL 60677-7001 CHECK NUMBER: 212966
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 328769 529 . 00 MEDICAL FEES
1091 4340700 328769 45 . 00 MEDICAL FEES
Invoice# 328769 (continued)page 2
746404 08/22/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Alicia Woodward Balance Due: S 45.00
Invoice# 328769 Balance Due: 574.00
PLEASE REMIT PAYMENT PROMPTLY
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Community Occupational Health Services
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0337
FEIN: 35-1955223 � � '; *
P 1 0 2012
Invoice
September 05, 2012
Bill to: Lynn Russell For: Cannel Clay Parks & Recreation
Cannel Clay Parks & Recreation 8/12
1411 E. 116th St.
Cannel, IN 46032-
Invoice# 328769
Proc Code ICD9 Date Description Qty Charge Receipt Adjust Balance
746404 1)892.0 08/12/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
2) E920.8
John R Aleksa Balance Due: 45.00
746404 08/21/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Amber Brown Balance Due: 45.00
80101 08/30/2012 E-Screen Rapid UDS 5 Panel 1.00 49.00 49.00
82075 08/30/2012 Breath Alcohol Test 1.00 30.00 30.00
Michelle L Dean Balance Due: S 79.00
746404 08/30/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Michelle Gillim Balance Due: C 45.00
746404 08/22/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 J 45.00
Lauren A Hofineister Balance Due: S 45.00
746404 08/22/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Patrick R Hurley Balance Due: S 45.00 `
746404 08/31/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Michelle A Kashman Balance Due: 45.00
746404 08/30/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Carol A Koch Balance Due: s 45.00
746404 08/16/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Brittany R Rowe Rent Balance Due: S 45.00
746404 08/31/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Madeleine M Stone Balance Due: S 45.00
746404 08/21/2012 Drug Screen-Non N I DA 5 Panel 1.00 45.00 45.00
Caleb L Sullivan Balance Due:S 45.00
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
9/5/12 328769 Pre-employment drug testing $ 45.00
9/5/12 328769 Pre-employment drug testing $ 529.00
Total $ 574.00
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$
$ 574.00
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE & 109 Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1091 328769 4340700 $ 45.00_ 1 hereby certify that the attached invoice(s), or
1081-99 328769 4340700 $ 529._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
20-Sep 2012
Signature
$ 574.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund