216000 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
0 I ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $282.00
CARMEL, INDIANA 46032 7169 SOLUTION CENTER
�. CHICAGO IL 60677-7001 CHECK NUMBER: 216000
CHECK DATE: 1/912013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 338223 235 . 00 MEDICAL FEES
1091 4340700 338223 47 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0337
FEIN: 35-1955223 �T��
DEC 2 0 2012
B g'.
Invoice
December 13, 2012
Bill to: Lynn Russell For: Cannel Clay Parks & Recreation
Cannel Clay Parks & Recreation 12-12**
1411 E. 1 16th St.
Cannel, IN 46032-
Invoice # 338223
Proc Code Date Description Qtv Charge Receipt Adiust Balance
746404 12/03/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Taylor A Backes Balance Due: 5 47.00
746404 12/04/2012 Drug Screen-Non NIDA 5 Panc1 1.00 47.00 47.00
Carrie Cunningham Balance Due: 47.00
746404 12/03/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Destiny F Davis Balance Due: S 47.00
746404 12/03/2012 Drug Screen-Non NIDA 5 Pancl 1.00 47.00 47.00
Timothy A Foster Balance Due: 47.00
746404 12/01/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Rachel N Markel Balance Due: S 47.00
746404 12/04/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
✓eanine Pottridge Balance Due: 47.00
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Invoice# 338223 Balance Due: 282.00
SLIGHT RATE INCREASE EFFECTIVE 11/01/2012,; PLEASE REMIT PAYMENT
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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
12/13/12 338223 Pre-employment drug testing $ 47.00
12/13%12 338223 Pre-employment drug testing $ 235.00
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
108 ESE & 109 MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1091 338223 4340700 $ 47.00 1 hereby certify that the attached invoice(s), or
1081-99 338223 4340700 $ 235.00 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
3-Jan 2013
Signature
$ 282.00 Accounts.Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund