HomeMy WebLinkAbout214601 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH ggi�gg
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CI�E�K AMOUNT: $100.00
CHICAGO IL 60677-7001 CHECK NUMBER: 214601
CHECK DATE: 11/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 333489 45 . 00 MEDICAL FEES
1091 4340700 333489 55 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001 C -11W�
Phone: 317-621-0337 OCT 2 2 2012
FEIN: 35-1955223
1':
Invoice
October 17, 2012
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks & Recreation 10/12
1411 E. 116th St.
Carmel, IN 46032-
Invoice # 333489
Proc Code Date Description Qty Charge Receipt Adipst Balance
720910 10/11/2012 Drug Screen-Rapid 10 Panel 1.00 55.00 55.00
Cassidy E Chapman Balance Due: 55.00
746404 10/05/2012 Drug Screen-Non NIDA 5 Panel 1.00 45.00 45.00
Nick A Goins Balance Due: 45.00
Invoice# 333489 Balance Due: 100.00
PLEASE REMIT PAYMENT PROMPTLY
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Cut and return with payment
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Please remit 100.00 to Conununity Occupational Health Services
7169 Solution Center
Please place invoice number 333489 on check Chicago,IL 60677-7001
Phone: 317-621-0337
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
10117/12 333489 Pre-employment drug testing $ 45.00
10/17/12 333489 Pre-employment drug testing $ 55.00
Total $ 100.00
I 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$
$ 100.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE/109 MCC
PO#or INVOICE NO. ACCT#[TITLE AMOUNT Board Members
Dept#
1081-99 333489 4340700 $ 45.00 1 hereby certify that the attached invoice(s), or
1091 333489 4340700 $ 55.00 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
15-Nov 2012
i Signature
$ 100.001 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund