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HomeMy WebLinkAbout315460 08/30/17 9CITY OF CARMEL, INDIANA VENDOR: 355031 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CWROK AMOUNT: $********51.00* ?�: CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 315460 M,�roN�u CHICAGO IL 60677-7001 CHECK DATE: 08/30/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 498284 51.00 MEDICAL EXAM FEES 0 k 0 -4 0 ƒ « q 0 O 2 2 = ? \ > / 0 c � ? n 0 E 2 m 0 e R < % J f q 0 0 q 0 a $ o z o z 0 � E ) k w n O w q / Co. # # / 2 f n , o 8 > o z / e / = O > 4 A Z o k a 7 # m m q $ q > 2 \ 0 I ® -n-n $O < > / 2 / q 2 \ § | $ , 4 a % 3 9 z > ¢ f = ( k ) E 0 CD E _ � CCL 0 D � / a k § c A § , 7 § _ C CD F k f 2 7 � R ¥ ƒ + ± & ƒ / k 9 ! \ § & o a am , 0) o a n / ƒ EF M k \ k \ � { / w S ( ƒ E ± I7 § o / 7 � ki e o � f 7 OL Q.ƒ \ \ - � G \ 0 47CD CD CD ` D / 27 \ \ C-) 7 � $ ° 0 �a 'a\ CD } 2 � \ ) � * 7 g () Z §> %i \ f \ �2 \ a ® CD 0 © ¢ = g \« } \ 9 Q = a D 6)g: ƒ ; q > / CL M CL< k / \ n { ( 0 E / c Q % G % / m * z \ ] /cn t CDO G / E $ CD CD n CD Z = o # ] 2 7 / - _ 0 0 CL § § ° # z / > \ \ ) _ e � g g � ƒ al \ k ® ) Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice August 02, 2017 Bill to: Jim Spelbring For: Carmel Police Department Carmel Police Department 07/17 1 Civic Square Carmel, IN 46032- Invoice# 498284 Proc Code ICD Date Description Q_yt Charge Receipt Adjust Balance 80301 1)R42 07/25/2017 Rapid 5 Panel UDS 1.00 51.00 51.00 2) Y33.XXX A Jennifer R Lane XXX-XX-0994 Balance Due: 51.00 Invoice# 498284 Balance Due: 51.00 Please remit payment promptly Cut and return with payment