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Home My WebLink About220114 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ! Q� ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH M&AMOUNT: $595.00 CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHICAGO IL 60677.7001 CHECK NUMBER: 220114 CHECK DATE: 5/21/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 050213 141 . 00 TESTING FEES 1081 4340700 348417 94 . 00 MEDICAL FEES 1082 4340700 348417 47 . 00 MEDICAL FEES 1091 4340700 348417 47 . 00 MEDICAL FEES 1081 4340700 349545 47 . 00 MEDICAL FEES 1082 4340700 349545 141 . 00 MEDICAL FEES 1125 4340700 349545 78 . 00 MEDICAL FEES Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0337 R, C7 .' `;.:,ED FEIN: 35-1955223 APR 18 2013 ]XV; Invoice April 15, 2013 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Cannel Clay Parks & Recreation 4/13 1411 E. 1 16th St. Cannel, IN 46032- Invoice # 348417 Proc Code ICD9 Date Description QtV Charge Recei t Ad'ust Balance 746404 04/02/2013 Drug Screcn-Non NIDA 5 Panel 1.00 47.00 47.00 Laurie K Copeland Balance Due: 47.00 746404 04/10/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Mary L Evans Balance Due: 47.00 746404 1) 729.5 04/02/2013 Drug Screcn-Non NIDA 5 Panel 1.00 47.00 ( 47.00 Misty L Gutierrez Balance Due: 5 47.00 746404 04/02/2013 Drug Screcn-Non NIDA 5 Panel 1.00 47.00 47.00 Alisha B Weber Balance Due: S 47.00 Invoice# 348417 Balance Due: 188.00 PLEASE REMIT PAYMENT PROMPTLY Purchase �(��/� � / Description��'1 t_.y��( `-� C!J P.O.# P i.ine`C)escr (� Purchas t J Approv , �3 yono — Y7 ac) Cut and return with payment y0 " — -------------------------------------- i '"- ---- --------------------- oI-0 = G ov Please remit 188.00 to Community Occupational Health Services 7169 Solution Center Please place invoice number 348417 on check Chicago, IL 60677-7001 Phone: 317-621-0337 Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0337 FEIN: 35-1955223 �.JFD MAY 0 0'2013 Invoice ': May 02, 2013 Bill to: Lynn Russell For: Cannel Clay Parks & Recreation Cannel Clay Parks & Recreation 4/13 1411 E. 1 16th St. Cannel, IN 46032- Invoice # 349545 Proc Code Date Description QtV Charge Receipt Adjust Balance 746404 04/30/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Ryan J Beery Balance Due: 47.00 746404 04/18/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 82075 04/18/2013 Breath Alcohol Test 1.00 31.00 31.00 John O Gates Balance Due: 78.00 746404 04/25/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Alix Goulden Balance Due: S 47.00 746404 04/30/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Mitchell L Greene Balance Due: C- 47.00 746404 04/27/2013 Drug Screen- Non NIDA 5 Panel 1.00 47.00 47.00 John P Spangler III Balance Due: 47.00 Invoice# 349545 Balance Due: 266.00 PLEASE REMIT PAYMENT PROMPTLY Purchase Description P.O.# PorF Budge*sO4 - /* Line D %3 Purch 7 Appro te iu �?i-99 - y31( o-7 o (b Y7- oo Cut"and ieii wyith payineni� — �'/3 ll 0 7 0) 2 g`0 L 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 4/15/13 348417 Pre-employment drug testing $ 47.00 4/15/13 348417 Pre-employment drug testing $ 47.00 4/15/13 348417 Pre-employment drug testing $ 94.00 5/2/13 349545 Pre-employment drug testing $ 47.00 5/2/13 349545 Pre-employment drug testing $ 141.00 5/2/13 349545 Pre-employment drug testing $ 78.00 Total $ 454.00 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$ $ 454.00 ON ACCOUNT OF APPROPRIATION FOR 101 General / 108 ESE/ 109 MCC PO#or INVOICE NO ACCT#/TITLE AMOUNT Board Members Dept# 1091 348417 4340700 $ 47.00 1 hereby certify that the attached invoice(s), or 1082-99 348417 4340700 $ 47.00 bill(s) is (are)true and correct and that the 1081-99 348417 4340700 $ 94.00 materials or services itemized thereon for 1081-99 349545 4340700 $ 47.00 which charge is made were ordered and 1082-99 349545 4340700 $ 141.00 received except 1125 349545 4340700 $ 78.00 16-May 2013 1 Signature $ 454.00 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 May 02, 2013 Bill to: Sue Coy For: Cannel Administration Cannel Administration 4/13 1 Civic Square Cannel, IN 46032- Invoice # 349670 Proc Code Date Description QtV Charge Receipt Adjust Balance 04/23/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 XXX-XX-3844 Balance Due: 47.00 746404 04/18/2013 NON-NIDA 5 Panel UDS 1.00 47.00 47.00 XXX-XX-3869 Balance Due: 47.00 746404 04/11/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 XXX-XX-7470 Balance Due: 47.00 Invoice# 349670 Balance Due: 141.00 PLEASE REMIT PAYMENT PROMPTLY I D MAY 2 0 Z013 By C"I .....with payment 1XIMM 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 service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s)or bill(s)) 05/02/13 05.02.13 $141.00 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. Community Occupational Health Services ALLOWED 20 IN SUM OF $ PO Box 19383 Indianapolis, IN 46219 $141.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 I 05.02.13 I 43-588.00 I $141.00 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 Monday, May 20, 2013 / Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund