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25D - AGMT - SEXUAL ASSAULT EXAMS
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01/15/2019
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25D - AGMT - SEXUAL ASSAULT EXAMS
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Last modified
1/10/2019 6:42:48 PM
Creation date
1/10/2019 6:34:39 PM
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Template:
City Clerk
Doc Type
Agenda Packet
Agency
Police
Item #
25D
Date
1/15/2019
Destruction Year
2024
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UCI CAST MEDICAL UNIT <br />_ <br />401 THE CITY DRIVE <br />UC Irvine Health <br />TEL 714-935-8456 <br />_. <br />FAx714-935-7796 <br />MAILPAYMENTTo: <br />INVOICE M 1717 10.23.2017 <br />BILL TO <br />TERMS: PAYMENT DUE 30 DAYS FROM INVOICE DATE <br />SANTAANA POLICE DEPARTMENT <br />MAKE CHECKS PAYABLE To: UC REGENTS <br />60 CIVIC CENTER PIZ <br />1. <br />SANTA'ANA,CA92701-4060 <br />MAILPAYMENTTo: <br />17-23751 <br />UC IRVINE PEDIATPoCSATTN: FINANCES DEPARTMENT <br />2. <br />333 CITY BLVD, WEST SUITE 800 <br />Non -Acute <br />ORANGE,CA 92868 <br />25D-17 <br />DATE OF ExAM <br />EXAM TYPE <br />POLICE DR # <br />'AMOUNT <br />1. <br />8/30/2017 <br />Non -Acute <br />17-23751 <br />$650.00 <br />2. <br />8/31/2017 <br />Non -Acute <br />17-23195 (Sibling 1) <br />$656.00 <br />3. <br />8/31/2017 <br />Non -Acute <br />17-23195 (Sibling 2) <br />$650.00 <br />ToTALAMoUNT DUE By 11.22.2017 <br />$1950.00 <br />25D-17 <br />
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