218422 03/25/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CFiEggi�gg
€ &AMOUNT: $376.00
CARMEL, INDIANA 46032 7169 SOLUTION CENTER
CHICAGO IL 60677-7001 CHECK NUMBER: 218422
CHECK DATE: 3/25/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 344295 282 . 00 MEDICAL FEES
1091 4340700 344295 94 . 00
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0337
FEIN: 35-1955223 MAR 0 8 2013
F_
Invoice
March 04, 2013
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Cannel Clay Parks & Recreation 2/13
1411 E. 116th St.
Cannel, IN 46032-
. _ .._ . ..-.
Invoice # 344295
Proc Code ICD9 Date Description Qty_ Charge Receipt Adjust Balance
746404 02/27/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Mackenzie T Bartelson Balance Due: 5 47.00
746404 02/27/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Tammy Cullen Balance Due: 5 47.00
746404 02/15/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Aaron M Hubbard Balance Due: S 47.00
746404 02/20/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
David M Leonard Balance Due: 47.00
746404 `t,02/19/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Nicholas M Matson Balance Due:•`MCIi 47.00
746404 02/13/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Anna M OConnell Balance Due: 47.00
746404 02/26/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Jennifer K Redkey-Choe Balance Due: S 47.00
746404 1)824.2 02/19/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
2) E880.9
Tiffany Swanson Balance Due: s 47.00
_l�
Invoice # 344295 (continued)page 2
Invoice# 344295 Balance Due: 376.00
PLEASE REMIT PAYMENT PROMPTLY
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P.O.# MAR 0 8 2013
qApproval
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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
3/4/13 344295 Pre-employment drug testing $ 94.00
3/4/13 344295 Pre-employment drug testing $ 282.00
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
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 344295 4340700 $ 94.00 1 hereby certify that the attached invoice(s), or
1081-99 344295 4340700 $ 282.00 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-Mar 2013
Signature
$ 376.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund