306407 12/21/16 �.'�,""'� CITY OF CARMEL, INDIANA VENDOR: 355031
i ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH WAW% AMOUNT: $'*'*****83.00*
,° CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 306407
��ori ' CHICAGO IL 60677-7001 CHECK DATE: 12/21/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 474822 83.00 TESTING FEES
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Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
Invoice
December 02, 2016
Bill to: Accounts Payable For: Carmel Fire Department
City of Carmel 11/16
1 Civic Square
Carmel, IN 46032-
Invoice# 474822
Proc Code Date Description QtV Char-ge Receipt Adjust Balance
80101 11/03/2016 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 11/03/2016 Breath Alcohol Test 1.00 32.00 32.00
Stephen J Reeves XXX-XX-5084 Balance Due: 83.00
Invoice# 474822 Balance Due: 83.00
Please remit payment promptly
Submitted To
DEC 13 2016
Clerk Treasurer
Cut and return with payment