HomeMy WebLinkAbout224833 10/08/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH URI<AMOUNT: $188.00
�qo CARMEL, INDIANA 46032 7169 SOLUTION CENTER
CHICAGO IL 60677-7001 CHECK NUMBER: 224833
CHECK DATE: 10/8/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 361991 188 . 00 MEDICAL FEES
Community Occupational Health Svs
\ 7169 Solution Center
Purchase ON )Chicago, IL 60677-7001
Ca.scription Phone: 317-621-0341
P.O.# P or F FEIN: 35-1955223 T I ,
G.L.# Df - o v o
&'&get ( l7tq rz4) S E p 210 2013
Ling.Desc
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Purchaser Date d0
BY:
Approval D.tta Invoice
September 16, 2013
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks & Recreation 9/13
1411 E. 116th St.
Carmel, IN 46032-
__._._..._.._....._.... _._._..............._... .._............._._._._._...._...._..v...._........._...._...._._...._.__..._..._...v........_______....._._............ ._._.._._. _.._._....._...._.._.._...........__..........__.._____.----.................._...__._... ......._......v....._.._......._........._........._.
Invoice # 361991
Proc Code ICD9 Date Description QQt Charge Receipt Adiust Balance
746404 09/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
'Amanda N Bowsher Balance Due: 47.00
746404 09/06/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
`/Megan Sherwood Balance Due: 47.00
746404 09/05/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
`Susan V Sizemore Balance Due: 47.00
746404 1)923.3 09/11/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
2)E918
Linda Vang Balance Due: 47.00
I �
Invoice# 361991 Balance Due: ✓ 188.00
PLEASE REMIT PAYMENT PROMPTLY
Cut and return with payment
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
9/16/13 361991 Pre-employment drug testing $ 188.00
Total $ 188.00
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$
$ 188.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1081-99 361991 4340700 $ 188.00 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
3-Oct 2013
$ 188.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund