241580 01/27/15 \f. CITY OF CARMEL, INDIANA VENDOR: 00350364
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $**"*****52.36*
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 241580
INDIANAPOLIS IN 46204 CHECK DATE: 01/27/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4341999 00-24792 52.36 OTHER PROFESSIONAL FE
Public Safety Medical - INVOICE
o Public Safety Medical Invoice Date: 01/14/2015 w
_ 324 E. New York Street Invoice# 00-24792
E Suite 300 Terms:
W. Indianapolis, IN 46204
o Carmel Police Department/CARMEPD
F- 3 Civic Square
on . Carmel, IN 46032
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee - Description Amount Balance Due
01 05/15 Soultz Me an Re eat Glucose Fastin Blood 22.85 22.85
Venipuncture $3.33 $3.33
01/08/15 McKay,Christo her A. Repeat Glucose Fastin Blood $22.85 $22.85
Venipuncture $3.33 $3.331
Total Charges->: $52.36
- - Total Pa ments"&Balance Due->' $0.00 $52.36
Please write invoice number on payment check. Our Federal Employer identification number is 35-2079797.
We greatly appreciate the opportunity to serve you. If you have any questions regarding this invoice, please contact
Debbie Pieper at 317-964-2330.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF$
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$52.36
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1110 I 00-24792 I 43-419.99 I $52.36 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
Wed nesdak January 21, 2015
�Z Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
i
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
01/14/15 00-24792 aplicant testing $52.36
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