226630 12/03/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1 gER
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CF &AMOUNT: $235.00
CARMEL, INDIANA 46032 7169 SOLUTION CENTER
CHICAGO IL 60677-7001 CHECK NUMBER: 226630
CHECK DATE: 12/3/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 365705 235 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223 �`-Kj
NOV - � 2013 r
BY:
1
Invoice
November 05, 2013
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks & Recreation 10-13
1411 E. 116th. St.
Carmel, IN 46032-
Invoice# 365705
Proc Code ICD9 Date Description Q�t Charge Receipt Adiust Balance
746404 10/10/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Chanella R Jackson Balance Due: S 47.00
746404 10/22/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Leah M Milliken Balance Due: S 47.00
_ _ ... _.._ - .........
746404 10/22/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Jacquelynn S Redmond Balance Due: S 47.00
746404 1)922.31 10/24/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
2)724.2
Mariana E Ruiz Balance Due: 47.00
746404 1)923.10 10/31/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
2)E968.7
Susan V Sizemore Balance.Due: 47.00
...........
Invoice# 365705 Balance Due: 235.00
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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
11/5/13 365705 Pre-employment drug testing $ 235.00
Total $ 235.00
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.
i
355031 Community Occupational Health Services Allowed 20
7169 Solution Center
Chicago, IL 60677-7001
In Sum of$
$ 235.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1081-99 365705 4340700 $ 235.00 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
27-Nov 2013
$ 235.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund