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316656 09/29/17 CITY OF CARMEL, INDIANA VENDOR: 355031 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH WROK AMOUNT: $.**""*235.00` CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 3166569, ) CHICAGO IL 60677-7001 CHECK DATE: 09/29/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 501955 235.00 MEDICAL FEES \ o v - % § OD CD 0 0 z CA) -% > 2 k k 0 0 w 0 m � 2 0 © = moo # A 2 ) E 22 ] 3 \ q 7 ƒ 2 § # § 0 k k a E . 7 e 0 2 7 \ \ k 0 / = O # ¥ m � -4 C4 / e ; q q 0 & $ \ 2 / 7 S a 7 2 Z \ w > m_ I m CL 2 d § 2 - k k 0 ƒ o k \ C-D ] LT / D \ / 0) ° CO $ < _ (D- 3 Q & & E CD ° o S 3 n q 7 = + ƒ $ m k CD M \ ( ® a E \ k 7 2 \ / CD / \ S k } % 0 \ 0 / / g \ D. \ / \ R m % A § o $ CL M CD d CD | \ R Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 FBY.E Phone: 317-621-0341FEIN: 35-1955223 SEP 2 12017 Invoice September 19, 2017 Bill to: Lynn Russell For: Carmel Clay Parks &Recreation Carmel Clay Parks &Recreation 09/17 1411 E. 116th St. Carmel, IN 46032- Invoice# 501955 Proc Code Date Description Qty Charge Receipt Adiust Balance 746404 09/05/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Jesse Crosby Balance Due: 47.00 746404 09/05/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Kaleb Dink Balance Due: 47.00 746404 09/12/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Amanda Dunn Balance Due: 47.00 746404 08/29/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Martina D Hall Balance Due: 47.00 746404 09/05/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Nicolette Wesley Balance Due: 47.00 Invoice# 501955 Balance Due: 235.00 Please remit payment promptly Cut and return with pays"" tr —-