213415 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