306805 01/06/17 (9)
CITY OF CARMEL, INDIANA VENDOR: COMM AMOUNT: S•""'*""82.00•
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CHECKCARMEL, INDIANA 46032 7169 SOLUTION CENTERCHECK NUMBER: 306805
CHICAGO IL 60677-7001 CHECK DATE: 01/06/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 459722 82.00 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
July 05, 2016
Bill to: Accounts Payable For: Carmel Fire Department
City of Carmel 06/16
1 Civic Square
Carmel, IN 46032-
Invoice# 459722
Proc Code Date Desch —QtY Charge Receipt Adjust Balance
80101 05/23/2016 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 05/23/2016 Breath Alcohol Test 1.00 31.00 31.00
Christopher M Ellison XXX-XX-0727 Balance Due: 82.00
Invoice# 459722 Balance Due: 82.00
Please remit payment promptly
PAST
Submitted To
JAN 0 3 2017
C1erk Trees=#rer
Cut and retun1 with payment