HomeMy WebLinkAbout226950 12/11/2013 CITY OF CARMEL, INDIANA VENDOR: 355031 Page 1 of 1
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH
�[K AMOUNT: $235.00
CARMEL, INDIANA 46032 7169 SOLUTION
TION CENTER C
CHICAGO IL 60677-7001 CHECK NUMBER: 226950
CHECK DATE: 12/11/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 367750 235 . 00 MEDICAL FEES
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223 NOV 2 0 2013
I
Invoice
November 14, 2013
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks &Recreation 11/13
1411 E. 116th St.
Carmel, IN 46032-
....._.._
Invoice# 367750
Proc Code Date Description Qty Charge Receipt Adiust Balance
746404 11/07/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 5 47.00
Donna Aiken Balance Due: 47.00
746404 11/08/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 5 47.00
Ryan Bowersox Balance Due: 47.00
746404 11/08/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Judith A Liederbach Balance Due: 47.00
746404 11/07/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
John J Reyes Balance Due: 47.00
746404 11/07/2013 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Kathryn E Soeder Balance Due: 47.00
Invoice# 367750 Balance Due: 235.00
PLEASE REMIT PAYMENT PROMPTLY
Purchase
'•�•# P or F
1_ine Dsscr
Purchaser
Approval _Date=o 1/3
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
11/14/13 367750 Pre-employment drug testing $ 235.00
Total $ 235.00
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
120
Clerk-Treasurer
Voucher No. Warrant No.
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 367750 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
5-Dec 2013
$ 235.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund