226080 11/18/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH MK AMOUNT: $141.00
CARMEL, INDIANA 46032 7169 SOLUTION CENTER
CHICAGO IL 60677-7001 CHECK NUMBER: 226080
CHECK DATE: 11/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 364667 141 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
-------- ----- Phone: 317-621-0341 -
FEIN: 35-1955223 FR--E fecEr-7 TAD
OCT 2 3 21M
BY:_-
Invoice —
October 18, 2013
Bill to: Lynn Russell For: Carmel Clay Parks &Recreation
Carmel Clay Parks &Recreation 10/13
1411 E. 116th St.
Carmel, IN 46032-
___...
Invoice# 364667
Proc Code Date Description Qty Charge Receipt Adjust Balance
746404 10/15/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
SJeanette M Beck Balance Due: 47.00
746404 10/04/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
15033932
Sydnee M Holly Balance Due: 47.00
746404 10/10/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
S Emily M Yarling Balance Due: 47.00
Invoice# 364667 Balance Due: 141.00
PLEASE REMIT PAYMENT PROMPTLY
;ti.CFve jJ OU�
i:r>�c;;ntion �wci
^.0.# PorF
G.L.# - Y V 07 DO
escr
Purchaser '
Approval Date—L-040210
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
10/18/13 364667 Pre-employment drug testing $ 141.00
Total $ 141.00
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.
i
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001 l
In Sum of$
$ 141.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or Board Members
Dept#
INVOICE NO. CCT#/TITL AMOUNT
1081-99 364667 4340700 $ 141.00 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
14-Nov 2013
$ 141.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund