221939 07/17/2013 a CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $427.00
s�? CARMEL, INDIANA 46032 7169 SOLUTION CENTER
p��a CHICAGO IL 60677-7001 CHECK NUMBER: 221939
CHECK DATE: 7/17/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4340700 353639 282 . 00 MEDICAL FEES
1091 4340700 353639 47 . 00 MEDICAL FEES
2201 4239099 355676 98 . 00 OTHER MISCELLANOUS
Community Occupational Health Svs
7169 Solution Center
Purchase ,l Chicago, IL 60677-7001
Description- P,4I Q s C(�ht Phone: 317- 621-0337
P.O.# PorF rfs9-v�FEIN: 35-1955223
Budget
Line Descr S 1 A BY.
Purchase D e J
Approval Date Invoice
10?a- 99 -- V3V0700 -t, ' June 17, 2013
/09/- q3V 0-7 00 dSa.00
Bill to: Lynn Russell y Op For: Cannel Clay Parks & Recreation
Cannel Clay Parks & Recreation 6/13
1411 E. 116th St.
Cannel, IN 46032-
Invoice # 353639
Proc Code Date Description _Qty Charge Receipt Adjust Balance
746404 06/05/2013 Drug Screen—Non NIDA 5 Panel 1.00 47.00 47.00
C,Martha Eelman Balance Due: 47.00
746404 06/09/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
CLeonid Nlelnikov Balance Due: 47.00
746404 06/06/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Q—Brittaney A Mulligan Balance Due: 47.00
746404 06/12/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
LGretchen S Sanftleben Balance Due: 47.00
746404 06/04/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
C, Rebecca A Walsh Balance Due: 47.00
746404 06/04/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
C_. , Teresa Wiley Balance Due: 47.00
746404 06/10/2013 Drug Screen-Non NIDA 5 Pancl 1.00 47.00 47.00
(�Anna K Zanoni Balance Due: 47.00
Invoice# 353639 Balance Due: 329.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and retUna with payment
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
6/17/13 353639 Pre-employment drug testing $ 282.00
6/17/13 353639 Pre-employment drug testing $ 47 00
Total $ 329.00
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$
$ 329.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE & 109 MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-99 353639 4340700 $ 282.00 1 hereby certify that the attached invoice(s), or
1091 353639 4340700 $ 47.00 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
10-Jul 2013
$ 329.00 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
July 03, 2013
Bill to: Jim Spelbring For: Carmel Street Dept.
Carmel Street Dept. 6/13
1 Civic Square
Cannel, IN 46032-
Invoice # 355676
Proc Code Date Description Qt! Charge Receipt Adjust Balance
06/27/2013 Respirator Fit Tcst 1.00 49.00 49.00
Evie M Anderson XXX-XX-7323 Balance Due: 49.00
06/27/2013 Respirator Fit Test 1.00 49.00 49.00
Thomas J Gilbert XXX-XX-3179 Balance Due: 49.00
Invoice# 355676 Balance Due: 98.00
PLEASE REMIT.PAYMENT PROMPTLY
I
Cut and retum with payment
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))
07/03/13 355676 $98.00
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 $
7169 Solution Center
Chicago, IL 60677-7001
$98.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I 355676 I 42-390.991 $98.00 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
Odne , July 10, 2013
uay&
Street Comr4oner
e m gioner
Cost distribution ledger classification if
claim paid motor vehicle highway fund