222358 07/30/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH gEg�[
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK AMOUNT: $94.00
CHICAGO IL 60677-7001 CHECK NUMBER: 222358
CHECK DATE: 7/3012013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4340700 354632 94 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0337
FEIN: 35-1955223 _
JUL -.8 2013
i
Invoice BY: -
July 03, 2013
Bill to: Lynn Russell For: Cannel Clay Parks & Recreation
Cannel Clay Parks & Recreation 6-13
1411 E. 116th St.
Cannel, IN 46032-
Invoice# 354632
Proc Code Date Description QQt it Charge Receipt Adiust Balance
746404 06/27/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Christina Castaneda Balance Due: 47.00
746404 06/16/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Ryan Sickle Balance Due: 47.00
Invoice# 354632 Balance Due: 94.00
PLEASE REMIT PAYMENT PROMPTLY
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Cut and return 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 # Arnount
7/3/13 354632 Pre-employment drug testing $ 94.00
Total $ 94.00
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$
$ 94.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-99 354632 4340700 $ 94.00 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
25-Jul 2013
$ 94.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund