The URL can be used to link to this page

Home My WebLink About215604 12/18/2012 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH M&AMOUNT: $282.00 a CARMEL, INDIANA 46032 7169 SOLUTION CENTER +. a� CHICAGO IL 60677-7001 CHECK NUMBER: 215604 CHECK DATE: 12/18/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 336862 282 . 00 MEDICAL FEES Community Occupational Health Svs 7169 Solution Center C� � Purchase hicago, IL 60677-7001 t n ,f Phone: 317-621-0337 Description 1 \ \l e C I Q S S { -<, - P�F FEIN: 35-1955223 P.O.# -- DEC 2012 IL Line esc► Purcha Date 2 1O� (2—Approval Date Invoice December 04, 2012 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Carmel Clay Parks & Recreation 11/12 1411 E. 116th St. Cannel, IN 46032- Invoice # 336862 Proc Code ICD9 Date Description Qty Charge Receipt Adjust Balance 746404 l 1/19/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Elizabeth Eppler Balance Due: -, 47.00 5' 746404 11/29/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 r' 47.00 Rachel Ireland Quarles Balance Due: 47.00 746404 11/13/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Hilary R Mettler Balance Due: 47.00 746404 11/19/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Alexander Pelton Balance Due: 47.00 746404 1)882.0 11/21/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 2) E920.3 Gail C Strong Balance Due: 47.00 746404 11/29/2012 Drug Screen-Non N I DA 5 Panel 1.00 47.00 47.00 Donna S Williams Balance Due: 47.00 Invoice# 336862 Balance Due: 282.00 PLEASE REMIT PAYMENT PROMPTLY Cut and return with payment 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 12/4/12 336862 Pre-employment drug testing $ 282.00 Total $ 282.00 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$ $ 282.00 ON ACCOUNT OF APPROPRIATION FOR 908 ESE PO#or INVOICE NO. ACCT#TTITLE AMOUNT Board Members Dept# 1081-99 336862 4340700 $ 282.00 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 13-Dec 2012 Signature $ 282.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund I