HomeMy WebLinkAbout233110 05/28/14 (9, )
CITY OF CARMEL, INDIANA VENDOR: 00350364
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $"""�"87.46'
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 233110
INDIANAPOLIS IN 46204 CHECK DATE: 05/28/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4340700 22962 87.46 MEDICAL FEES
INVOICE
Public Safety Medical Services `I
�. 324 E. New York Street
E: Suite 300 MAY ® 9 z01471
W: Indianapolis, IN 46204
e Carmel Clay Parks&Recreation/CARMELPARK
4- Attn: Jeff Kramer Terms
1411 E. 116th Street Invoice Date 05/07/2014
'
In Invoice# 00-22962
Carmel, IN 46032
Date ..Employee Description Amount ;Balance Due'
04/30/14 Wright,Paula A. Hepatitis B Vacc#3 $76.52 $76.52
hection Fee $10.94 10.94
Total Charges-> $87.46
Total Payments Balance.Due->: . $0.00 $87.46
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35-2079797 date
Purchase �-
Description
P.O.# PorF
G.L.# WDaa1(9;_
O
Budget
Line DescrPurchas rApproval
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc,
Payee
Purchase Order No.
00350364 Public Safety Medical Services Terms
324 E. New York Street, Ste 300
Indianapolis, IN 46204
Invoice Invoice Description
Date Number 'or note attached invoice's)or bill's)) PO# Amount
__ 5/7/14 22962 Medical fees $ 87.46
Total $ 87.46
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20—
Clerk-Treasurer
Voucher No. Warrant No.
00350364 Public Safety Medical Services Allowed 20
324 E. New York Street, Ste 300
Indianapolis, IN 46204 j
In Sum of$
$ 87.46
i
{
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
I
Po#or Board Members
INVOICE NO. CCT#MTL AMOUNT
Dept#
1091 22962 4340700 $ 87.46 1 hereby certify that the attached invoice(s), or
bill(s) is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
22-May 2014
I
i
Signature
$ 87.46 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund