Loading...
HomeMy WebLinkAbout317577 10/19/2017 ,y u,C�gye �;; � CITY OF CARMEL, INDIANA VENDOR: 355031 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTHQVRVK AMOUNT: $""""**462.00* f? 4 CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 317577 "1f TON.`. CHICAGO a 60677-7001 CHECK DATE: 10/19/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340799 332.00 OTHER MEDICAL FEES 1201 4358800 503762 47.00 TESTING FEES 1201 4358800 504696 83.00 TESTING FEES n 0 d 0 < « \ § § § k 0 2 2f ? } 0 / p ^ m 0w e J % m E a 2 � < E k o 7 O % % \ c ® q 0 0 c m ] O 1 m E \ ° ƒ \ m % @ 0 0 � / k 3 r- / 3 § % E \ g 2 m 2 \ ^ I > k � w ¥ 3 55o o $ 0 > -n / / q / < . E c z | = o a & ) & 3 9 - 2 > e I E (D ƒƒ c § CL / - F 2 § m E $ j ® G v :3n CD a - CD CD CD r 2 % 3 f 2 7 7 9 $ E . Z 7 o , CD Co § :E \2 & q ƒ 7 /7 { ; ; ƒ k / $ \ \ 0 \ 4 C 7 a k ƒ § , 2 a o / c - a ƒƒ %Ime E E , CD CD \ § \ } m 2 $ k D / .« ) (-) E � � § C / g CD0 [ }} � ) � m ƒ C ) J ' # # 7 0 z ( _ \ E U g �_< CCDr _0 f0. , \ � D CD §o ) o a E §� { � f r cl m CO \ n } j U \ r O ¥ W ] i E ; C % (D / G § } \� q d k 2 _� M c 8 m ] CD k CL > k \ § 69K CD a 7 0 ƒ 00 § � � \ Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice October 03, 2017 Bill to: Jim Spelbring For: Carmel Civilian Carmel Utilities 9/17 1 Civic Square Carmel, IN 46032- Invoice# 504696 Proc Code Date Description QtV Charge Recei t Adjust Balance 80301 09/27/2017 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 09/27/2017 Breath Alcohol Test 1.00 32.00 32.00 PATRICK RIGDON XXX-XX-1940 Balance Due: 83.00 Invoice# 504696 Balance Due: 83.00 Please remit payment promptly Subm *ted TO OCT 112017 Clerk Treasurer n n 2 n o # f $, « } k 2O§ 2 2 / A n > b / n 0 r 2 ® m 0 q E % a 2 $ < z k Z R w § o ° ® w n n \ § -n / / ] D � w R CD0 m / { § \ } / 2 $ $ © D / ® a z I ® / > $ O ` 0O k j \ Z ( 7 o w Sr ƒ \ i 7 / 0 k k g k /_ £ J i k ) (a - CD 3 ; v ® = f 7 / \ ( / I \ 0 § :k CL m E \ &ƒ \ §\ . % \ ? = m N ; K 2 . w o L a g 2 E m CL m 00\ g! =r E - o CL a 2 , w \C k \ o E = g � / | k i , k qo k J > / ( }ƒ \ § m (D k k \ .« ) \ g § k -n < a_ $ 0 ou E Q 0 k j(D § k_ ƒ \ C o \\ CD ' / 0 7E§ k c \ � a[ �\ E 2 -0 D CA CD \ \ oD e0 Eo K > co ƒ 0 \ \ » 2 0 CD n / \ \ j E \ \ O ¥_ & % j E @ c f ® R a CD n n z r p OL2 / CD m 'n § Q m f L ] f \ © 7 a z \ \ E _ K & ; \ E § E CD . § (C) Community Occupational Health Svs 7169 Solution Center Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice October 03, 2017 Bill to: Accounts Payable For: Carmel Fire Department City of Carmel 09/17 1 Civic Square Carmel, IN 46032- Invoice# 504046 Proc Code Date Description Qt Charge Receipt AdLst Balance 09/20/2017 Return to Work Exam 1.00 120.00 12D�00- Steven W Holubik XXX-XX-2818 Balance Due: --411rm . . ....................._......... 80301 08/23/2017 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 08/23/2017 Breath Alcohol Test 1.00 32.00 32.00 Anthony Mowery XXX-XX-6776 Balance Due: 83.00 80301 07/26/2017 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 07/26/2017 Breath Alcohol Test 1.00 32.00 32.00 David A Mulford XXX-XX-0601 Balance Due: 83.00 80301 08/23/2017 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 08/23/2017 Breath Alcohol Test 1.00 32.00 32.00 Dustin Schooler XXX-XX-9032 Balance Due: 83.00 80301 07/26/2017 Rapid 5 Panel UDS 1.00 51.00 51.00 82075 07/26/2017 Breath Alcohol Test 1.00 32.00 32.00 Kent C Steury XXX-XX-9435 Balance Due: 83.00 09/29/2017 Return to Work Exam 1.00 120.00 -20-0e Submitted To ����` 1, _ an C Thomas XXX-XX-7837 Balance Due: 2,0„pg- '� OCT 10 2017 Invoice# 504046 Balance Due: 572.00 Clerk Treasurer Please remit payment promptly d - Cut and return with payment Please remit-571:00 to Community Occupational Health Services 7169 Solution Center Please place invoice number 504046 on check Chicago,IL 60677-7001 Phone: 317-621-0341 n Q n n $ « \ § \ § k 0 2 2f E / ^ 0 0 / ^ m \ q e % m $ g <_ 2 Z k Z R / q / / § 2 k w 2 e o a -0 / CD § 2f c k / \ j CD m / ^ > f ° z � I w ( > -n m O < 0 0 } \ § | z ° � / a g = - z > £ 52. / g (n § % i + / \ § K , ? ; -n o 3 CD CDm at ¥ ° $ ? + { - E CD� ¢ $ \ 2 K 0 CDƒ % k k % / ƒ � � E CL C < 0) S ( E E w E § f %ƒ \ 9§ v i - U)\ \ a 2 0. 2 w # - E 0) CD D / \/ - 3 \ 7 n ( a -nI a 0 o o Co E ] k \ R q 2 / k } # # # mg m « 2 / iE K Ecr # | \{ � � \ G_ } 0- - CD �®)o C) D� D 2 § \ / m / 0 9 f a z Ej $ ( { C ƒ 3 / @ a m m C / } n B k 2 M -n c 8 mCD ] CD ; 5) R § � \ z Cl > & ; - o C Z ° \ Community Occupational Health Svs 7169 Solution Center 1 Chicago, IL 60677-7001 Phone: 317-621-0341 FEIN: 35-1955223 Invoice October 03, 2017 Bill to: Sue Wolfgang For: Carmel Administration Carmel Administration 09/17 1 Civic Square Carmel, IN 46032- Invoice # 503762 Proc Code Date Description (qty Charge Receipt Adjust Balance 80101 09/18/2017 NON-NIDA 5 Panel UDS 1.00 47.00 47.00 Alex P Brown XXX-XX-1776 Balance Due: 47.00 Invoice# 503762 Balance Due: 47.00 Please remit payment promptly Submitted To OCT 10 2017 Clerk Treasurer Cut and return with payment --------------