HomeMy WebLinkAbout248493 08/12/15 CITY OF CARMEL, INDIANA VENDOR: 00350364
® I ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: S""""1,053.09;
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 248493
'M�roH .r INDIANAPOLIS IN 46204 CHECK DATE: 08/12/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 26287 1,053.09 MEDICAL EXAM FEES
Public Safety Medical - INVOICE
F-
0 Public Safety Medical Invoice Date: 07/29/2015 -
._ 324 E. New York Street Invoice# 00-26287
E Suite 300 Terms:
W Indianapolis, IN 46204
o Carmel Fire Department/CARMEFD
F— Attn: Asst Chief David Haboush
m 2 Civic Square
Carmel, IN 46032
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
06/25/15 Thom son James L. Fitness For Duty Exam Initial Level 2 $190.34 $190.34
PSY-Fit For Duty Psych Eval Initial $862.75 $862.75
Total Charges-> $1,053.09
Total Payments&Balance Due > $0.00 $1,053.09
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.
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))
26287 Thompson $1,053.09
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.
ALLOWED 20
Public Safety Medical Services
IN SUM OF $
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$1,053.09
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 26287 1120-407.01 $1,053.09 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 AUG 10 2015
l
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund