218004 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $455.00
CARMEL, INDIANA 46032 7169 SOLUTION CENTER
CHICAGO IL 60677-7001 CHECK NUMBER: 218004
CHECK DATE: 3/1312013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 343261 79 . 00 OTHER EXPENSES
1081 4340700 343305 329 . 00 MEDICAL FEES
1091 4340700 343305 47 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center ��i CFJ QED
Chicago, IL 60677-7001
Phone: 317-621-0337 FEB 2 6 2013
FEIN: 35-1955223
Invoice
February 20, 2013
Bill to: Lynn Russell For: Carinel Clay Parks & Recreation
Cannel Clay Parks & Recreation 2-13
1411 E. 116th St.
Cannel, IN 46032-
Invoice# 343305
Proc Code Date Description QtV Charge Receipt Adjust Balance
746404 02/04/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
John R Aleksa Balance Due: 47.00
746404 02/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Shandi N Bray Balance Due: 47.00
746404 02/15/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Ariana F Brown Balance Due: 47.00
746404 02/06/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Linda Hotz Balance Due: 47.00
746404 02/07/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Brian P Lahti Balance Due: 47.00
746404 02/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Bryan Pratt Balance Due: 47.00
746404 02/07/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Katherine A Reeder Balance Due: 47.00
746404 02/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Alyssa R Weber Balance Due: 47.00
Invoice# 343305 (continued)page 2
Invoice# 343305 Balance Due: V%'` 376.00
PLEASE REMIT PAYMENT PROMPTLY
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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
2/20/13 343305 Pre-employment drug testing $ 47.00
2/20/13 343305 _ Pre-employment drug testing
Total $ 376.00
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 l
Chicago, IL 60677-7001
In Sum of$
$ 376.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE / 109 MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1091 343305 4340700 $ 47.00 1 hereby certify that the attached invoice(s), or
1081-99 343305 4340700 $ 329.00 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
7-Mar 2013
Signature
$ 376.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0337
FEIN: 35-1955223
Invoice
February 20, 2013
Bill to: Jim Spelbring For: Cannel Utilities
Cannel Utilities 2/13
1 Civic Square
Cannel, IN 46032-
Invoice# 343261
Proc Code Date Description Qty Charge Recei t Ad'lust Balance
02/01/2013 Whisper Test 1.00 8.00 8.00
81002 02/01/2013 Urinalysis, Mini Dip w/Physical 1.00 8.00 8.00
99173 02/01/2013 Sncllen 1.00 8.00 8.00
99386 02/01/2013 DOT/PPCL Exam 1.00 55.00 55.00
Gary Merrill XXX-XX-0949 Balance Due: 79.00
Invoice# 343261 Balance Due: 79.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and return with payment
VOUCHER # 135039 WARRANT # ALLOWED
I
355031
IN SUM OF $
COMMUNITY OCCUPATIONAL HEALTf
7169 Solution Center i
Chicago, IL 60677-7001
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
343261 01-7752-05 $79.00
I
Voucher Total $79.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
355031
COMMUNITY OCCUPATIONAL HEALTH Purchase Order No.
7169 Solution Center Terms
Chicago, IL 60677-7001 Due Date 3/6/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/612013 343261 $79.00
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
Date Officer