HomeMy WebLinkAbout317776 10/25/17 F 1+u,GAgMf
>; CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH WjQK AMOUNT: $......*423.00*
rq_ CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 317776
�.y. CHICAGO IL 60677-7001 CHECK DATE: 10/25/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 503306 376.00 MEDICAL FEES
1125 4340700 503306 47.00 MEDICAL FEES
CD v -0 K 0
00 m0 a =
& U e0 k � �
> 2
n 0 0 0
/ CD \§ / 0 (q q
q q n G) Z Cl)
ƒ { 0) 0)§ § Q \ \
m e -�
} S w 0 T k 0
# # ® o # -4 m
C) �
k m � \
] o o ® CO o $ /
M 2
A \ w 40 �_ I P
2 O M
2 -
p .4 Z 0 c
CD R q
/
] / E D
n 7 m = m
f ¢ f @ ƒ $
E $ M z ] A
x a 0 Q 3
> m Z
0 O 2 c
@
0
k CD §
W J 7 ° - /
) ƒ A 7 t / § k 2
k \ \
o m a
CDCD CL / ƒ
k § 7 A ] C)
/ CL / � \
|
0 0
• Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341 FBY:
11ED
FEIN: 35-1955223
6 1011
Invoice
October 03, 2017
Bill to: Lynn Russell For: Carmel Clay Parks& Recreation
Carmel Clay Parks & Recreation 09/17
1411 E. 116th St.
Carmel, IN 46032-
Invoice # 503306
Proc Code Date Description Qty Chane Receipt Adjust Balance
746404 09/26/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Brian T Alich Balance Due: 47.00
746404 09/26/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Kama Clevenger Balance Due: 47.00
746404 09/21/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Anthony D Fletcher Balance Due: 47.00
746404 09/26/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Natalie N Jackson Balance Due: 47.00
746404 09/13/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Rebecca L Navarro Balance Due: 47.00
746404 09/21/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Chris Petrulis Balance Due: 47.00
746404 09/18/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Alissa Rex Balance Due: 47.00
. ............... .............
746404 09/19/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Jacob Smith Balance Due: 47.00
746404 09/20/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Allison Wray Balance Due: 47.00
Invoice# 503306 Balance Due: 423.00
Please remit payment promptly
Invoice# _.....�__.. __ . _... �..._ ........ __
503306 (continued)page 2
,� Cut and return with payment