216668 01/29/2013 *f CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
` ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH SFfE�SE��g�[
CARMEL, INDIANA 46032 7169 SOLUTION CENTER K AMOUNT: $141.00
CHICAGO IL 60677-7001 CHECK NUMBER: 216668
CHECK DATE: 1/29/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 339176 141 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0337
FEIN: 35-19552236'- TjjT_,i D
JAN 10 2013
B.Y
Invoice
January 04, 2013
Bill to: Lynn Russell For: Cannel Clay Parks & Recreation
Cannel Clay Parks & Recreation 12/12
1411 E. 116th St.
Cannel, IN 46032-
Invoice # 339176
Proc Code Date Description QtV Charge Receipt Adjust Balance
746404 12/27/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Natalie A Berry Balance Due: S 47.00
746404 12/19/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Leonid Melnikov Balance Due: S 47.00
746404 12/13/2012 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Mariana E Ruiz Balance Due: 47.00
Invoice# 339176 Balance Due: 141.00
PLEASE REMIT PAYMENT PROMPTLY
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Purchaser Date 13
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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 PO# Amount
Date Number (or note attached invoice(s) or bill(s))
$ 141.00
1/4/13 _ 339176 Pre-emplo ment drug testing
Total $ 141.00
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$
$ 141.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-99 339176 4340700 $ 141.00 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
24-Jan 2013
Signature
$ 141.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund