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221465 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $1,410.00 CARMEL, INDIANA 46032 7169 SOLUTION CENTER o„o� CHICAGO IL 60677-7001 CHECK NUMBER: 221465 CHECK DATE: 7/2/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 351937 235 . 00 MEDICAL FEES 1082 4340700 351937 1, 175 . 00 MEDICAL FEES Community Occupational Health Svs 7169 Solution Center Purchase Chicago, IL 60677-7001 Phone: 317-621-0337 FEIN: 35-1955223 C.L.# ED Budget JUN 0 7 2013 1-1:;E Descr Purchaser Date gy: Approval Invoice Date June 04, 2013 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Cannel Clay Parks & Recreation 5/13 1411 E. 1 16th St. .. Cannel, M 46032- Invoice # 351937 Proc Code ICD9 Date Description QtV Charge Receipt Adjust Balance 746404 05/30/2013 Drug Scrccn- Non NIDA 5 Panc1 1.00 47.00 47.00 Paula Botta Balance Due: C 47.00 746404 05/22/2013 Drug Scrccn-Non NIDA 5 Panel 1.00 47.00 47.00 Madison A Brake Balance Due: C- 47.00 746404 05/13/2013 Drug Scrccn- Non NIDA 5 Panel 1.00 47.00 47.00 Haley Alliso C Breeden Balance Due: S 47.00 746404 05/18/2013 Drug Scrccn-Non NIDA 5 Panel 1.00 47.00 47.00 Brittany Brown Balance Due: S 47.00 746404 05/18/2013 Drug Scrccn-Non NIDA 5 Panel 1.00 47.00 47.00 Megan Burge Balance Due: S 47.00 746404 05/17/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 David W Connors Balance Due: 47.00 746404 05/23/2013 Drug Scrccn-Non NIDA 5 Panel 1.00 47.00 47.00 Daniel J Drier Balance Due: C. 47.00 746404 05/18/2013 Drug Scrcen-Non NIDA 5 Panel 1.00 47.00 47.00 Blake Dunshee Balance Due: 47.00 746404 05/16/2013 Drug Screen-Non NIDA 5 Pancl 1.00 47.00 47.00 Kevin M Fleming Balance Due: (` 47.00 746404 05/13/2013 Drug Scrccn -Non NIDA 5 Panel 1.00 47.00 47.00 Halie R Griffin Balance Due: �- 47.00 746404 05/25/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Janet C Karsas Balance Due: 47.00 746404 1)923.21 05/18/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 2)727.05 Invoice # 351937 (continued)page 2 Carol A Koch Balance Due: S 47.00 746404 05/15/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Erin C Libby Balance Due: 47.00 746404 05/13/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Julia Marsan Balance Due: C� 47.00 746404 05/15/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Mary McCaulay Balance Due: C, 47.00 746404 05/17/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Maria S Metaxas Balance Due: 47.00 746404 05/17/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Makenzie R Monastro Balance Due: t. 47.00 746404 05/30/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Alex J Mueller Balance Due: �- 47.00 746404 05/10/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Richard A Murray Balance Due: 47.00 746404 05/16/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Dunya D Rasouli Balance Due: 47.00 746404 05/18/2013 Drug Screen -Non NIDA 5 Panel 1.00 47.00 47.00 Parker S Redelman Balance Due: �- 47.00 746404 05/16/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Collin E Skiles Balance Due: C- 47.00 746404 05/21/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 CARLA SLATES Balance Due: 47.00 746404 05/13/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Tracey L Smith Balance Due: 47.00 746404 05/17/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Kasey J Sons Balance Due: C- 47.00 746404 05/30/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Reginald Steele Balance Due: 47.00 746404 05/18/2013 Drug Screen- Non NIDA 5 Panel 1.00 47.00 47.00 Catherine E Surette Balance Due: �'' 47.00 746404 05/23/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Mary G Wessel Balance Due: L 47.00 746404 05/17/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 - •z_. iR% e rx"tA � - - :#,;4.2ir' -'"k" n"'`- - ON, zt%- 4,Invoice# 351937 (continued) page 3 Larissa M White Balance Due: 47.00 746404 05/24/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Brighton W Yau Balance Due: 47.00 Invoice# 351937 Balance Due: ✓ 1410.00 PLEASE REMIT PAYMENT PROMPTLY Purchase / \ -.`„r ct:on l'b��,ln;/-rn eS ��u.Q 1�)T /1 P.O.' PorF Li c Doscr _� eS I I'LL ,J Purchaser ate G l l3 Appmval Date —�-� 1 1 Cut and return%WQA payMUA g 11 Fa w°.s g �i �° 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 6/4/13 351937 Pre-employment drug testing $ 235.00 6/4/13 351937 Pre-employment drug testing _ $ 1,175.00 Total $ 1,410.00 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$ $ 1,410.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1081-99 351937 4340700 $ 235.00 1 hereby certify that the attached invoice(s), or 1082-99 351937 4340700 $ 1,175.00 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 20-Jun 2013 $ 1,410.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund