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HomeMy WebLinkAbout312361 06/13/17 a; ;� CITY OF CARMEL, INDIANA VENDOR: 355031 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH TMFOK AMOUNT: $********83.00* +° CARMEL, INDIANA 46032 C7169 HICAGO ION CEN 001 CHECK NUMBER: 312361 o„ CHECK DATE: 06/13/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340799 492291 83.00 OTHER MEDICAL FEES n 0 -4 0 < « § \ k / / k / 7 c ° O / 7 m \ O e g a CA 2 E � < z E 2 0 / O % q Q w 4 0 q \ § / / \ a _0 0 A -n > m O / » � � kE � CD I m 3 � k > & --Iz I w / ? 0 < 2 7 . j \§ | a o ¥ # _ 2) a 3 R # k / 0 \ / / k k ` q ff 2 m o % n § 3 - O k z ® 2 k fCL § \ CL m ID \ ƒ / % 3 a ? r (Da - J E % @ 0 o k g ° U) 2 E _ » « \k ƒ /(- w , S R E & / 7 f § c � / [CD c f 7 > CL # ( CD § ) i A / 3 i \ ; k # -n z / 0 } C \ C) 0 2 \ D \ 2 � © ■ } g Z » 4 3 § o k k k \ 0_o mo. � \f CD §\ � D # - W % 7 r f 2 0 \ / . � < 0 / / } \ ° \ D 5 a C 0 ( § $ / } a g $ ] / E \ G / \ } } § E 9 ƒ CD \ _ 0 C j k ° \ Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice June 02, 2017 Bill to: Accounts Payable For: Carmel Fire Department City of Cannel 05/17 1 Civic Square Cannel, IN 46032- Invoice # 492291 Proc Code Date Description Qty Charge Receipt Adjust Balance 80301 05/18/2017 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 05/18/2017 Breath Alcohol Test 1.00 32.00 32.00 Jason S Force XXX-XX-6442 Balance Due: 83.00 Invoice# 492291 Balance Due: 83.00 Please remit payment promptly