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215300 12/11/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $329.00 y4.�. CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHICAGO IL 60677-7001 CHECK NUMBER: 215300 CHECK DATE: 12/11/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 335869 329 . 00 MEDICAL FEES Community Occupational Health Svs 7169 Solution Center L7N Chicago, IL 60677-7001 jV y)Phone: 317-621-0337 FEIN: 35-1955223 V:3 Q ?BIZ Invoice November 15, 2012 Bill to: Lynn Russell For: Cannel Clay Parks & Recreation Cannel Clay Parks & Recreation 11/12 1411 E. 116th St. Cannel, IN 46032- Invoice # 335869 Proc Code ICD9 Date Description Qty Charge Receipt Adjust Balance 746404 11/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Tammie L Carter Balance Due: 47.00 746404 11/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Torre J Durrett Balance Due: 47.00 746404 11/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Hannah M Engling Balance Due: tT 47.00 746404 11/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Heather L Salmeron Balance Due: G- 47.00 746404 11/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Corynna L Sitek Balance Due: = 47.00 746404 11/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Debra J Thrash Balance Due: C 47.00 746404 1)913.8 11/06/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 2)E968.7 Purchase Description M V`Q�l�Ii l rf e S Mollie E Whitmer Balance Due: L 47.00 G.L.# g - 7 I ©� II Invoice# 335869 Balance Due: 329.00 u-'JCt /�Q d C �P-S C1- 9 TQSTS) Ullo Descr "urchaser Date PLEASE REMIT PAYMENT PROMPTLY %Pr;pIoval _ Date f Z t and retu`_�niwith- ncnt 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 11/15/12 335869 Pre-employment drug testing $ 329.00 Total $ 329.00 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$ $ 329.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1081-99 335869 4340700 $ 329.00 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 6-Dec 2012 Signature $ 329.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund