HomeMy WebLinkAbout213890 10/23/2012 a CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH gER�[
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK AMOUNT: $405.00
'? CHICAGO IL 60677-7001
,o CHECK NUMBER: 213890
CHECK DATE: 10/2312012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 331073 405 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0337
FEIN: 35-1955223 OCT n 2012
Invoice
October 02, 2012
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks & Recreation 9/12
1411 E. 116th St.
Carmel, IN 46032-
Invoice # 331073
Proc Code ICD9 Date Description Qty_ Charge Receipt Adjust Balance
746404 09/24/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Regann M Bell Balance Due: S 45.00
746404 09/18/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
James J Cortright Balance Due: 45.00
746404 09/18/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Desiree Daniels Balance Due: S 45.00
746404 09/26/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Diane DeVietien Balance Due: S 45.00
746404 09/25/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Jacob T King Balance Due: 45.00
746404 1)845.00 09/12/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
2)E885.9
Gbassan S Maarouf Balance Due: 45.00
746404 09/17/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Jessica Mason Balance Due: S 45.00
746404 09/25/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Justin Seifried Balance Due: 45.00
746404 09/17/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Katie Sofanopoulos Balance Due: 45.00
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Purchase
e acri fi on fC(� CL
P.O.# P or F /� Invoice# 331073 Balance Due: 405.00
G.L.#^ �_ _ y3 y U U
Budget P EV ASE REMIT PAYMENT PROMPTLY
Line Descr
Purchase
Approval _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
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
10/2/12 331073 Pre-employment drug testing $ 405.00
Total $ 405.00
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$
$ 405.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-99 331073 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
i
which charge is made were ordered and
received except
18-Oct 2012
Signature
$ 405.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund