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HomeMy WebLinkAbout225327 10/23/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CHECK AMOUNT: $564.00 o CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHICAGO IL 60677-7001 CHECK NUMBER: 225327 CHECK DATE: 10123/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 362792 564 . 00 MEDICAL FEES Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-19552237BY: ' 015 -----._.� Invo ice October 02, 2013 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Cannel Clay Parks & Recreation 9/13 1411 E. 116th St. Cannel, IN 46032- Invoice # 362792 Proc Code Date Description Qty Charge Receipt Adjust Balance 746404 09/18/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Clayton A Allen Balance Due: 47.00 746404 09/17/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Matthew T Anderson Balance Due: 47.00 746404 09/24/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Deaysia R Bennett Balance Due: 47.00 746404 09/24/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Francisco M Bergamo Balance Due: `> 47.00 746404 09/16/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Marie C Burge Balance Due: 47.00 746404 09/25/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jasmine D Burgess Balance Due: S 47.00 746404 09/16/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Asia N DeBerry Balance Due: 5 47.00 746404 09/25/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Cara Gray Balance Due: 47.00 746404 09/24/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Glenn P Harper Balance Due: `j 47.00 746404 09/16/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Lisabeth F King Balance Due: S 47.00 '!1404 09/16/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Adrianna Mason Balance Due: 47.00 746404 09/25/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Invoice# 362792 (continued)page 2 Debra S Russell Balance Due: 5 47.00 Invoice# 362792 Balance Due: 564.00 PLEASE REMIT PAYMENT PROMPTLY Purchase �p PorF lt18 t)e.cr -eeS eS Purchase. Date !3 Approval Data g l 2 y o lost— 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 # Amount 10/2/13 362792 Pre-employment drug testing $ 564.00 Total $ 564.00 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$ $ 564.00 i ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO#or INVOICE NO. ACCT#[TITLE AMOUNT Board Members Dept# 1081-99 362792 4340700 $ 564.00 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 17-Oct 2013 $ 564.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund