221003 06/18/2013 i
CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CHE�K AMOUNT: $940.00
CARMEL, INDIANA 46032 7169 SOLUTION CENTER
CHICAGO IL 60677-7001 CHECK NUMBER: 221003
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 350851 188 . 00 MEDICAL FEES
1082 4340700 350851 705 . 00 MEDICAL FEES
1091 4340700 350851 47 . 00 MEDICAL FEES
I
Community Occupational Health Svs
Purchase 7169 Solution Center
Description - z Chicago, IL 60677-7001
P.O.# P or F Phone: 317-621-0337
FEIN: 35-1955223 `T-f 7--r"
i�e'escr C�J S 7MAY 21 2013 i
Purchaser at
Approval Date
Invoice
I q/= y3 V07 0 0 - Y7. 00
!0 1?1- 9 ? Y3Y0700 -- 4 !X8. 00 May 16, 2013
/0&a- 49- Y3Y0700 - ff 00
Bill to: Lynn Russell For: Cannel Clay Parks & Recreation
Carmel Clay Parks & Recreation 5-13
1411 E. 1 16th St.
Cannel, IN 46032-
Invoice # 350851
Proc Code Date Description Qty_ Charge Receipt Adlust Balance
746404 05/06/2013 Drug Scrccn-Non NIDA 5 Panel 1.00 47.00 47.00
Lauren J Bangs Balance Due: C 47.00
746404 05/08/2013 Drug Screen- Non NIDA 5 Panel 1.00 47.00 47.00
Sydney A Bartel Balance Due: 47.00
746404 05/09/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
George B Botros Balance Due: 47.00
746404 05/10/2013 Drug Screen -Non NIDA 5 Panel 1.00 47.00 47.00
Margaret C Duxbury Balance Due: s 47.00
746404 05/12/2013 Drug Screcn-Non NIDA 5 Panel 1.00 47.00 47.00
lulia S Goins Balance Due: r 47.00
746404 05/11/2013 Drug Screen-Non NIDA 5 Pancl 1.00 47.00 47.00
Benjamin N Hatfield Balance Due: 47.00
746404 05/10/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Jennifer K Hunt Balance Due: S 47.00
746404 05/09/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Stephanie M Lukas Balance Due: 47.00
746404 05/09/2013 Drug Screen-Non N I DA 5 Panel 1.00 47.00 47.00
Caroline G Marshall Balance Due: C 47.00
746404 05/10/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Hanna McBride Balance Due: 47.00
746404 05/09/2013 Drug Screen-Non NIDA 5 Pancl 1.00 47.00 47.00
Lauren M McRoberts Balance Due: V 47.00
746404 05/07/2013 Drug Screen- Non NIDA 5 Panel 1.00 47.00 47.00
Invoice # 350851 (continued) page 2
Matthew L Nicisenhelder Balance Due: C- 47.00
746404 05/07/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Amanda Monaghan Balance Due: (� 47.00
746404 05/12/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 v 47.00
Grace Pickering Balance Due: 47.00
746404 05/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Andrew J Riley Balance Due: 47.00
746404 05/08/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Sydney Smith Balance Due: G 47.00
746404 05/09/2013 Drug Screen-Non NIDA 5 Pancl 1.00 47.00 47.00
Katie M Tourney Balance Due: 47.00
746404 05/09/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Kristen H Trimpe Balance Due: C 47.00
746404 05/08/2013 Drug Screen- Non NIDA 5 Panel 1.00 47.00 47.00
Annesia R Wright Balance Due: S 47.00
746404 05/03/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Stacey Zimmerman Balance Due: 47.00
Invoice# 350851 Balance Due: 940.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and return with payment
Li
ACCOUNTS PAYABLE VOUCHER
i
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.
PayeIe
I Purchase Order No.
355031 Community Occupational Health Services Terms
7169 Solution Center
Chicago, IL 60677-7001
i
rl
Invoice ` Invoice Description
Date 'Number (or note attached invoice(s) or bill(s)) PO # Amount
5/16/13 350851 Pre-employment drug testing $ 47 00
5/16/13 350851 Pre-employment drug testing $ 188.00
5/16/13 350851 Pre-employment drug testing $ 705.00
r�
ii
'I
Total $ 940.00
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.
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 940.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE/ 109 MCC
PO#or Board Members
INVOICE NO. ACCT#/TITL AMOUNT
Dept#
1091 350851 4340700 $ 47.00 1 hereby certify that the attached invoice(s), or
1081-99 350851 4340700 $ 188.00 bill(s) is (are)true and correct and that the
1082-99 350851 4340700 $ 705.00 materials or services itemized thereon for
which charge is made were ordered and
received except
13-Jun 2013
Signature
$ 940.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund