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HomeMy WebLinkAbout307763 01/30/17 �,c,',,� CITY OF CARMEL, INDIANA VENDOR: 355031 " ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CMRVK AMOUNT: S''" ""267.00` ,� ,+' CARMEL, INDIANA 46032 7169 SOLUTION CENTER 9CHECK NUMBER: 307763 , CHICAGO IL 60677-7001 CHECK DATE: 01/30/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 479059 94.00 MEDICAL FEES 1125 4340700 479059 79.00 MEDICAL FEES 1081 4340700 479877 94.00 MEDICAL FEES « o \ % 0 0_ 2220 7 = % (ID Z* k 2 m > 2 o o 0 R £ \ 0 0 -40 30)# # # g O © 7 % o , A w w w o E 0 o ] 3 \ R R % m m 0 ƒ 2 ( / CYI$ $ v j § Q 7 < E 7 e —� S S S 0 0 \ E # # # ® o q � / cc L % q q q O � 44 6 7 § / 0 0 0 R ® � ƒ 2 $ / — m Z \ / 4 + + + _\ I P 2 O E Z — cn 74 $ N 7 Z 0 \ . 2 R R R ) \ § « ] R / :3 > n ° m R § f ƒ 0 k = � & 7 E ¥ J ] E q ° 0 G 3 ƒ � q ( . § /j f \ @ E CL@ q / e m — C / ƒ g $ \ § k 2 k \ / CDS A » & 0 - CD & ƒ § \ B 7 A ] o / � / / CD 0 R Community Occupational Health Svs R�,i`CR I V E D 7169 Solution Center Chicago, IL 60677-7001 JAN 2 0 2011 Phone: 317-621-0341 FEIN: 35-1955223 BY:. Invoice January 16, 2017 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Carmel Clay Parks & Recreation 01/17 1411 E. 116th St. Carmel, IN 46032- Invoice# 479877 Proc Code Date Description Qty Charge Receipt Adjust Balance 746404 01/12/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Katherine M Bentivglio Balance Due: 47.00 746404 01/12/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Elisabeth M Scott Balance Due: 47.00 Invoice# 479877 Balance Due: 94.00 Please remit payment promptly o Cut and return with payment _ Community Occupational Health Svs 7169 Solution Center RE CM I�WED Chicago, IL 60677-7001 Phone: 317-621-0341 JAN 0 2017 FEIN: 35-1955223 BY: Invoice January 16, 2017 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Carmel Clay Parks & Recreation 01/17 1411 E. 116th St. Cannel, M 46032- Invoice# 479059 Proc Code Date Description QtV Charge Receipt Adjust Balance 746404 01/12/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jacob A Bandawal Balance Due: 47.00 746404 01/12/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 82075 01/12/2017 Breath Alcohol Test 1.00 32.00 32.00 Jeff Bartle Balance Due: 79.00 746404 01/04/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Callie M Daet Balance Due: 47.00 Invoice# 479059 Balance Due: 173.00 Please remit payment promptly D Cf� Cut and return with payment