220563 06/04/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH C}�E�ggi�gg
K AMOUNT: $79.00
CARMEL, INDIANA 46032 7169 SOLUTION CENTER
9MON CHICAGO IL 60677-7001 CHECK NUMBER: 220563
CHECK DATE: 6/4/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 349903 79 . 00 OTHER EXPENSES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0337
FEIN: 35-1955223
Invoice
May 02, 2013
Bill to: Jim Spelbring For: Cannel Utilities
Cannel Utilities 4/13
1 Civic Square
Cannel, IN 46032-
Invoice # 349903
I-
Proc Code Date Description QtV Charge Receipt Adjust Balance
04/22/2013 Whisper Test 1.00 8.00 8.00
81002 04/22/2013 Urinalysis, Mini Dip w/Physical 1.00 8.00 8.00
99173 04/22/2013 Snellcn 1.00 8.00 8.00
99386 04/22/2013 DOT/PPCL Exam 1.00 55.00 55.00
Robbie L Kinkead XXX-XX-4535 Balance Due: 79.00
Invoice# 349903 Balance Due: 79.00
PLEASE REMIT PAYMENT PROMPTLY
01 , -115j . 05
Cut and return with payment
i— --------------
Please remit 79.00 to Cotmnunity Occupational Health Services
7169 Solution Center
Please place invoice number 349903 on check Chicago,IL 60677-7001
Phone: 317-621-0337
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 5/23/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/23/2013 349903 $79.00
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
Date Officer
VOUCHER # 135607 WARRANT # ALLOWED
355031 IN SUM OF $
COMMUNITY OCCUPATIONAL HEALTI
7169 Solution Center
Chicago, IL 60677-7001
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
349903 01-7752-05 $79.00
Voucher Total $79.00
Cost distribution ledger classification if
claim paid under vehicle highway fund