217599 02/26/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
4 � ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $280.00
CARMEL, INDIANA 46032 7169 SOLUTION CENTER
CHICAGO IL 60677-7001 CHECK NUMBER: 217599
CHECK DATE: 2126/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 341535 94 . 00 MEDICAL FEES
1091 4340700 341535 186 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0337 CEIVED
FEIN: 35-1955223 FEB 1 1 2013
Invoice
February 05, 2013
Bill to: Lynn Russell For: Cannel Clay Parks & Recreation
Cannel Clay Parks & Recreation 1/13
1411 E. 116th St.
Cannel, IN 46032-
........
Invoice # 341535
Proc Code Date Description QQt r Charge Receipt Adiust Balance
746404 01/23/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Laura L Deneen Balance Due: S 47.00
01/14/2013 Review Questionnaire 1.00 1.00 1.00
0104/2013 Respirator Fit Test 1.00 49.00 49.00
01/14/2013 Fitness To Wear Respirator Exam 1.00 75.00 75.00
94010 01/14/2013 Spiromety w/o Bronchodilator 1.00 61.00 61.00
Nichole M Haberlin Balance Due: 186.00
746404 01/23/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Charlsie A Krauss Balance Due: < 47.00
Invoice# 341535 Balance Due: 280.00
Purchase PLEASE REMIT PAYMENT PROMPTLY
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Approval Date
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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
$ 186.00
215/13 341535 Pre-employment drug testing 94.00
2/5/13 341535 Pre-emplo ment drug testing $
Total $ 280.00
I 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$
$ 280.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE/ 109 MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1091 341535 4340700 $ 186.00 1 hereby certify that the attached invoice(s), or
1081-99 341535 4340700 $ 94.00 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
21-Feb 2013
Signature
$ 280.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund