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313217 07/05117 CITY OF CARMEL, INDIANA VENDOR: 355031 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH C NQK AMOUNT: $*******329.00* ?4 CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 313217 ' CHICAGO IL 60677-7001 CHECK DATE: 07/05117 �IoM co DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 494139 329.00 MEDICAL FEES 0 0 0 -0 %00 CD 0 Ln § 0 z -1 2 n 0 0 0 E [ n 40 0 -40 k % co \ C F co\ 0 k ® Er # co § o m � 7 R0� / % # 0 / 2 / 0 2: U ® 2 N q / s �q ) 0 w -4E\ / [ R H $ 2 C) a 2 [ _/ 4A + % I P 2 z g Z C.) 9 0 2 © § 0 ƒ k R k / Q « ] R J # 0 0) = f ¢ / 3 Q CD ƒ $ & & cr 3 E q 0 Q 3 > Q k � 7 a k0 7 ) / � C 2 / 2 Zr @ $ ƒ ± J 9 ) ƒ k 00 % \ 0 2 2 ® CD \ CD S _ \ o � a / ® \ / I / \ R 0 2 0 j o � / / 3. Cor D CD f | 0 0 Community Occupational Health Svs ` 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 JUN 1 9 2017 BY: .................... Invoice June 15, 2017 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Carmel Clay Parks & Recreation 06/17 1411 E. 116th St. Carmel, IN 46032- Invoice# 494139 Proc Code Date Description Qty Charge Receipt Adjust Balance 746404 06/09/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Kyla M Breland Balance Due: 47.00 746404 06/02/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Halie R Griffin Balance Due: 47.00 746404 06/08/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Alana M Lorts Balance Due: 47.00 746404 06/08/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Kerryn J Quarles Balance Due: 47.00 746404 06/08/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Emily K Reich Balance Due: 47.00 746404 06/09/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Charlotte E Russell Balance Due: 47.00 746404 06/021/20117 Drug Screen. -Non NIDA 5 Pane: 1.00 47.00 47.00 Haley Wilson Balance Due: 47.00 Invoice# 494139 Balance Due: 329.00 Please remit payment promptly 6. 1 q Cnl Cut and return with payment