310363 04/18/17 CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH GbAQK AMOUNT: $*******188.00*
=q; CARMEL, INDIANA 46032 7169 SO ISL ION CENTER
7001 CHECK NUMBER: 310363
CHECK DATE: 04/18/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 485885 141.00 MEDICAL FEES
1091 4340700 485885 47.00 MEDICAL FEES
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Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
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NPR 0 7 2017
BY:
Invoice
April 04, 2017
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks & Recreation 3/17
1411 E. 116th St.
Carmel, IN 46032-
Invoice# 485885
Proc Code Date Description QtV Charge Receipt Adiust Balance
746404 03/14/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Freddy Delfin Balance Due: 47.00
746404 03/28/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Megan G Grasso Balance Due: 47.00
746404 03/29/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Emily Katter Balance Due: 47.00
746404 03/21/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
James Monson Balance Due: 47.00
Invoice# 485885 Balance Due: 188.00
Please remit payment promptly
Cut and return with payment