217098 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
�0 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $188.00
i CARMEL, INDIANA 46032 7169 SOLUTION CENTER
CHICAGO IL 60677-7001 CHECK NUMBER: 217098
CHECK DATE: 211 312 01 3
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 340641 188 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0337
FEIN: 35-1955223
JAN 18 2013
Invoice
January 15, 2013
Bill to: Lynn Russell For: Cannel Clay Parks & Recreation
Cannel Clay Parks & Recreation 1/13
1411 E. 116th St.
Cannel, IN 46032-
Invoice # 340641
Proc Code Date Description Qty Charge Receipt Adiust Balance
746404 01/09/2013 Drug Screcn-Non NIDA 5 Panel 1.00 47.00 47.00
Ronald H Bell Balance Due: c 47.00
746404 01/11/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Mario L Brown Balance Due: 47.00
746404 01/03/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Joshua M Lane Balance Due: s 47.00
746404 01/09/2013 Drug Screen-Non NIDA 5 Pane] 1.00 47.00 47.00
Lucy E Moreman Balance Due: 5 47.00
Invoice# 340641 Balance Due: -188.00
PLEASE REMIT PAYMENT PROMPTLY
PUichass
A�
Description
P.O.# P F
G.L. 7 U U
Budqet
Line Descr
Purchaser te_,
Approval Date
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
1/15/13 340641 Pre-employment drug testing $ 188.00
Total $ 188.00
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$
$ 188.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#[TITLE AMOUNT Board Members
Dept#
1081-99 340641 4340700 $ 188.00 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
7-Feb 2013
Signature
$ 188.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund