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Home My WebLink About213415 10/09/2012 ��. CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH SHE�gEERR h K AMOUNT: $479.00 CARMEL, INDIANA 46032 7169 SOLUTION CENTER sr-; CHICAGO IL 60677-7001 CHECK NUMBER: 213415 CHECK DATE: 10/9/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 297866 74 . 00 OTHER EXPENSES 1081 4340700 330658 405 . 00 MEDICAL FEES Community Occupational Health Services 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0337 FEIN: 35-1955223D SEP 1 9 2.012 Invoice September 13, 2012 Bill to: Lynn Russell For: Cannel Clay Parks & Recreation Cannel Clay Parks & Recreation 9/12 1411 E. 116th St. Cannel, IN 46032- Invoice# 330658 Proc Code Date Description QtV Charge Receipt Adjust Balance 746404 09/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Chanel R Dean.Balance Due: S 45.00 746404 09/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Dillion Duxbury-Balance Due: S 45.00 746404 09/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Tia J Goodloe Balance Due: S 45.00 746404 09/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Misty L Guitierrez Balance Due: S 45.00 746404 09/07/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Emily Janecek Balance Due: 45.00 746404 09/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Antoine Lewis Balance Due: 45.00 746404 09/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Nicole S Schramm Balance Due: 45.00 746404 09/11/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Spencer A Thornton Balance Due: S 45.00 746404 09/11/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00 Mary F Tilford Balance Due: 1� 45.00 Purchase Description AA � (4-es- (� /�S Invoice# 330658 Balance Due: 405.00 ParR G # u; PLEASE REMIT PAYMENT PROMPTLY Budget 70 Ms-. ,0 Line Decor Purchaser I 1 Z J Approv Date_,_ 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 PO# Amount Date Number (or note attached invoice(s)or bill(s)) 9113112 330658 Pre-emplo ment dru testin $ 405.00 Total $ 405.00 I hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and l 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$ $ 405.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1081-99 330658 4340700 $ 405.00 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 4-Oct 2012 7f' Signature $ 405.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund Community Nealth Network 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0337 FEIN: 35-1955223 Invoice August 04, 2011 Bill to: Jim Spelbring For: Carmel Utilities Carmel Utilities 7/11 1 Civic Square Carmel, IN 46032- Invoice # 297866 ST-04 Proc Code Date Description QtV Charge Receipt Adjust Balance 07/08/2011 Whisper"Pest 1.00 7.00 7.00 81002 07/08/2011 Urinalysis; Mini Dip\v/Physical 1.00 7.00 7.00 99173 07/08/2011 Snellcn 1.00 7.00 7.00 99386 07/08/2011 DOT/PPCL Exam 1.00 53.00 53.00 David L Turner XXX-XX-2951 Balance Due: 74.00 Invoice# 297866 Balance Due: 74.00 PLEASE REMIT PAYMENT PROMPTLY .� Cut and return x\,ith payment 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 of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 355031 COMMUNITY OCCUPATIONAL HEALTH Purchase Order No. 7169 Solution Center Terms Chicago, IL 60677-7001 Due Date 10/2/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 10/2/2012 297866 $74.00 hereby certify that the attached invoice(s), or bill(s) is (are) true and orrect and I have audited same in accordance with IC 5-11-10-1.6 Date Officer VOUCHER # 125802 WARRANT # ALLOWED 355031 IN SUM OF $ COMMUNITY OCCUPATIONAL HEALTI 7169 Solution Center Chicago, IL 60677-7001 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO # INV# ACCT# AMOUNT Audit Trail Code i0N" 297866 01-7q'f;2-05 $74.00 Voucher Total $74.00 Cost distribution ledger classification if claim paid under vehicle highway fund