Loading...
311663 5/30/2017 ♦d C�qy* 355031 „�,a ;� CITY OF CARMEL, INDIANA VENDOR: COMM ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTHCM'lROK AMOUNT: S""""""""*7.00* �� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 311663 CHICAGO IL 60677-7001 CHECK DATE: 05/30/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340799 485876 7.00 OTHER MEDICAL FEES / m ?_ k q / O + -02 2 0 9f C \ n 0 / / ® k q R � S C % < z k Z R / m C" Q w w 0 n \ m n 0 v \ ~ j D 7 k / / R £ -0 S 5 m Ca -n O / / E G § E n I ƒ 3 d � © D $ d \ 2 � I w / > m 9 m O 7 C | / § ¥ $ J $ 3 9 - z r- £ E $ [ / / k k % i » ƒ o m e , E ^ - � 2 m 2 / O I \ / C cD i C E CL , . § I E 0 / k & I % RE K 2 o L CD� k °kC - 0)g \= / / » CL { - k� E 7 f g � o � » - e « 7 %« & m § E s; kƒ § § m \ / k CD .« § k -n < / a� (3 \ � / 2 \ l ow CD° Z > n f 3 2 R CD --i � / 0 7a % e/ \ $_0. ° © Q 0 D }_ /_ CD ( §o & Ko E § ƒ 0 \ / 2 J X 7 $ / CD j E CD c . Q 7 k z E ] $ c « % ( \ " O 0) f ƒ CD CD / } q B k k 2 2. 0 P \ § CD / \ } k k \ \ E > & a \ / o ° \ k ° \ Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice April 04, 2017 Bill to: Accounts Payable For: Carmel Fire Department City of Cannel 3/17 1 Civic Square Carmel, IN 46032- Invoice # 485876 Proc Code Date Description QtV Charge Receipt Adiust Balance NWO1 03114,'2017 Rapid 5 Panel UDS 1.00 51.00 51.00 52075 03;14;2017 Breath Alcohol Test 1.00 32.00 32.00 Jeff W Fuchs XXX-XX-6663 Balance Due: 83.00 Invoice# 485876 Balance Due: 83.00 Please remit payment promptly Cut and rctum with payment Please remit 83.00 to Community Occupational Health Services 7169 Solution Center Please place invoice number 485876 on check Chicago, IL 60677-7001 Phone: 317-621-0341 CITY OF CARMEL, INDIANA VENDOR: 355031 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH99M AMOUNT: 5""""76.00• (9) CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 310297 CHICAGO IL 60677-7001 CHECK DATE: 04/18/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340799 485876 76.00 OTHER MEDICAL FEES