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Home My WebLink About218004 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 Purchase / ( /l / Description 0,4L Y�(� s OrU3/Pits) P.O.# P or F Cuc+.get -�-/� � \ Purchaser ate z z(d 13 Approval Gate y30700 45- y7Ob qq - Cut and retum with navment 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