Loading...
HomeMy WebLinkAbout307160 01/20/17 1�w..4+.Rrf CITY OF CARMEL, INDIANA VENDOR: 355031 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTHfARVK AMOUNT: $*"`**"239.00` s ,=4; CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 307160 � CHICAGO IL 60677-7001 CHECK DATE: 01/20/17 M`roN,, DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 477304 188.00 MEDICAL FEES 1201 4358800 478534 51.00 TESTING FEES < C) 20 Co / k0 z - > g \ � a 0 © =r o 2 -4 \ E a 2 ] 3 q o o \ \ 2 § � O \ co 7 e &l< $& m > 00 CO) C) 0 0 $ e n ® ° m m e w # ® _ 4 _ / 0C) T FO ® C \ 0 ® 2 C) £ z } o © © > I 0 K z E g 2 — $ k k 0 / 2 k j / § » ] / ± n mm @ o Z =r - (D § $ & \ UT & l< a ) ° 0 S n g CD- > . maw 0 C- j / § \ m E E f J 9 D m \ ƒ 3 ( \ 2 m / o & \ / C � 2 q & EL / w m m — ƒ o % / k ] o \ & — / 7 | \ / 7 a 2 R * Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 R . V,7 77 PD Phone: 317-621-0341 FEIN: 35-1955223 JAN 0 9 2017 BY: Invoice January 04, 2017 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Carmel Clay Parks &Recreation 12/16 1411 E. 116th St. Carmel, IN 46032- Invoice# 477304 Proc Code ICD Date Descriotion Qt( Charge Receipt Adjust Balance 746404 1) 12/22/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 S67.195A 2) W23.OXX A Benjamin N Hatfield Balance Due: 47.00 746404 12/15/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Kaijah J Monson Balance Due: 47.00 746404 12/14/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Cierra I Spink Balance Due: 47.00 746404 12/15/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jacqueise C Yates Balance Due: 47.00 Invoice# 477304 Balance Due: 188.00 Please remit payment promptly Cut and return with payment ----------------------------------- — ------------------------------------------------------------- — — n n -4 n < « j § \ § k K 2 2 ƒ O / 0 0 / ^ m p \ q e % m Cil 2 Z 2 k R $ O = 9 c w w n n ( 2 q ] O -4 z % 2 69 ; 0 _ o e / q / 3 § § \ d 7 m q \ > k w_ w \ 0 � § m 0 > -n / 2 E q < E o z | = o H « 0 & 2 - z R £ I g (k ( § % i n E E 7 § m m E 0 a ; -n o CD ; § ; + - r g f £ q 2 « 3 w ° k g / t C f kr § / CD CD 8 M % k k 0 2 / ƒ - cak \ CL � { , % ( 2 CL 77 ƒ 7 § \ E ; � - ƒ \£ # / m CL - § k -1 r e § m A # - ; E cr k/ 0 \ 0 k 0) :r -n < E 0 % 2 _ -4 E o 8 / § m ƒ (D ) / ^ k 0 Z ( _ \ K) @%E k E g | cr ;\0 0 > / \ D 0 D $o ) Q a « nm D � / \ n = } j E \ r r O ¥ 2 % ] i E a C % ¢ / E $ / \ 7 n B k 2 _� M { CO) 8 m ;u ] k k CD CD z kCL > \ § CD § _ § ? ) / § ° ® \ Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice January 04, 2017 Bill to: Jim Spelbring For: Carmel Police Department Carmel Police Department 12/16 1 Civic Square Carmel, IN 46032- Invoice# 478534 Proc Code Date Description —QtY Charge Receipt Adjust Balance 80103 12/22/2016 Rapid 5 Panel UDS 1.00 51.00 51.00 Steven Cash XXX-XX-7311 Balance Due: 51.00 Invoice# 478534 Balance Due: 51.00 Please remit payment promptly Submitted To JAN 10 2017 Clerk Treasurer Cut and return with payment