224242 09/23/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
�! ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $470.00
a CARMEL, INDIANA 46032 7169 SOLUTION CENTER
CHICAGO IL 60677-7001 CHECK NUMBER: 224242
CHECK DATE: 9/23/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 360439 470 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Pere"ase �S C "L9)Chicago, IL 60677-7001
Description - 12S{ Phone: 317-621-0341
P.O.# P or F FEIN: 35-1955223 OD
c.L.# l 0 `/3071 5V70, 00
Line D` � �t� L escr 1_ina U
Purchaser Date
'. proval Date Invoice SAP 0 2013
September 04, 2013 BY:
Bill to: Lynn Russell For: Cannel Clay Parks & Recreation
Carmel Clay Parks & Recreation 8/13
1411 E. 116th St.
Cannel, IN 46032-
..._..__. .....__,..... ��.._ _.._. .._.._. . . _..__ .......... _.............. ._.............................---......._........ _. ___..�..__
Invoice # 360439
Proc Code ICD9 Date Description Qty Charge Receipt Adjust Balance
746404 08/19/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Alexander B Carpenter Balance Due: S 47.00
746404 08/29/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Olivia L Chance Balance Due: `j 47.00
746404 08/19/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Christopher R Evans Balance Due: 47.00
746404 08/30/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Stephany Harbaugh Balance Due: 47.00
746404 08/30/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Macy Jensen Balance Due: 47.00
746404 08/19/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Robbin Mason Balance Due: S 47.00
746404 08/19/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Megan Riley Balance Due: 47.00
746404 1)844.9 08/26/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
2)E917.9
Justin Seifried Balance Due: S 47.00
746404 08/29/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Elizabeth Van Hoose Balance Due: 47.00
746404 08/31/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Kayla L Walker Balance Due: S 47.00
Invoice# 360439 Balance Due: � 470.00
PLEASE REMIT PAYMENT PROMPTLY
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
9/4/13 360439 Pre-employment drug testing $ 470.00
Total $ 470.00
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$
$ 470.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1081-99 360439 4340700 $ 470.00 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
19-Sep 2013
$ 470.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund