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223437 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH gig CARMEL, INDIANA 46032 7169 SOLUTION CENTER S R�K AMOUNT: $1,347.00 CHICAGO IL 60677-7001 CHECK NUMBER: 223437 CHECK DATE: 8/2712013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 357442 376 . 00 MEDICAL FEES 1082 4340700 357442 141 . 00 MEDICAL FEES 1081 4340700 359002 705 . 00 MEDICAL FEES 1091 4340700 359002 47 . 00 MEDICAL FEES 1125 4340700 359002 78 . 00 MEDICAL FEES .......... ,, '. ,"-........... .......................................... ......... ..... .... .. ..... Invoice # 357442 (continued)page 2 Invoice# 357442 Balance Due: 517.00 PLEASE REMIT PAYMENT PROMPTLY Cut and return with payment Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 �-tU . 4 3hone: 317-621-0341 35-1955223 P or F o 9-06 oo g/- 3 Lira Jescr 9 - 1 Purchaser Date Approval ateAff T�10 Invoice -- August 05, 2013 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Carmel Clay Parks & Recreation 7/13 1411 E. 1 16th St. Cannel, IN 46032- Invoice # 357442 Proc Code ICD9 Date Description QtV Charge Receipt Adjust Balance 746404 07/31/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Heidi S Babcock Balance Due: 47.00 746404 07/25/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 .-5 47.00 Byron K Benning Balance Due: 47.00 746404 07/17/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Mark A Connors Balance Due: 47.00 746404 07/25/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 5 47.00, Briana J Dowdell Balance Due: 47.00 746404 07/23/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Joshua C Ebik-,i,o Balance Due: 47.00 746404 07/25/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 5 47.00 Kyrsten Q Ford Balance Due: 47.00 746404 07/30/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Thomas A Gerow Balance Due: 47.00 746404 07/31/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Joshua D Harrell Balance Due: 47.00 746404 1)840.9 07/16/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 2)959.2 - Basel G Maarouf Balance Due: C' 47.00 746404 07/25/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 S- 47.00 Joel P Meier Balance Due: 47.00 746404 07/24/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jacob Z York Balance Due: 47.00 Invoice# 359002 (continued)page 2 746404 08/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Kylie K Montgomery Balance Due: 5 47.00 746404 08/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Kayla M Phillips Balance Due: 47.00 746404 08/06/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Briana Rains Balance Due: S 47.00 746404 08/08/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Amani R Sadek Balance Due: S 47.00 746404 08/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Elizabeth M Sheridan Balance Due: ' 47.00 i 746404 08/09/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jacquese R Waters Balance Due: S 47.00 Invoice# 359002 Balance Due: 830.00 PLEASE REMIT PAYMENT PROMPTLY Cut and return with payment Community Occupational Health Svs 7169 Solution Center Purchase ,f' r � P 5Vhicago, IL 60677-7001 Description Phone: 317-621-0341 RECEIVED P.O.# P or F FEIN: 35-1955223 AUG 19 2013 E3udget \ LinDescr ,(w -f-es � q TES> s) BY• Purchaser Approval e i 9 �� Invoice 0700 - y7•oo August 15, 2013 - �U- 7o o - #qg, Au a s ovo -- y-3yo J /08/-99 - V 3V 0700 - -tl 70'5 .' p Bill to: Lynn Russell For: Cannel Clay Parks & Recreation Cannel Clay Parks & Recreation 8/13 1411 E. 116th St. Cannel, IN 46032- Invoice# 359002 Proc Code Date Description QtV Charge Receipt Adiust Balance 746404 08/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jessica A Bookout Balance Due: iS 47.00 746404 08/06/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 82075 08/06/2013 Breath Alcohol Test 1.00 31.00 ( 31.00 f Andrew W Burnett Balance Due: rAvu 78.00 746404 08/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Megan E Carr Balance Due: S 47.00 746404 08/06/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Taryn M Ford Balance Due: 47.00 746404 08/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Eden Gill Balance Due: 47.00 746404 08/01/2013 Drug Screen- Non NIDA 5 Panel 1.00 47.00 47.00 --- --- ------ Michelle Gilli►n Balance Due: 47,00 746404 08/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jennifer C Gunnels Balance Due: 47.00 746404 08/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Joseph J Hammond Balance Due: 47.00 746404 08/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Kimberly S Howse,Balance Due: 5 47.00 746404 08/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jameslia K Jones Balance Due: C 47.00 746404 08/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Michael S Kilpatrick Balance Due: /y1 47.00 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 8/5/13 357442 Pre-employment drug testing $ 141.00 8/5/13 357442 Pre-employment drug testing $ 376.00 8/15/13 359002 Pre-employment drug testing $ 47.00 8/15/13 359002 Pre-employment drug testing $ 78.00 8/15/13 359002 Pre-employment drug testing $ 705.00 Total $ 1,347.00 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$ w $ 1,347.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members Dept# 1082-99 357442 4340700 $ 141.00 1 hereby certify that the attached invoice(s), or 1081-99 357442 4340700 $ 376.00 bill(s) is (are)true and correct and that the 1091 359002 4340700 $ 47.00 materials or services itemized thereon for 1125 359002 4340700 $ 78.00 which charge is made were ordered and 1081-99 359002 4340700 $ 705.00 received except 22-Aug 2013 $ 1,347.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund