HomeMy WebLinkAbout253185 01/11/16 ♦d_Cggb
�`` CITY OF CARMEL, INDIANA VENDOR: 00350364
i ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: 5""`t'"888.93'
?q CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 253185
�'�ro`N�. INDIANAPOLIS IN 46204 CHECK DATE: 01111/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 00-27355 26.18 MEDICAL EXAM FEES
1120 4340701 27354 862.75 MEDICAL EXAM FEES
Public Safety Medical - INVOICE
to Public Safety Medical I Invoice Date: 12/23/2015
324 E. New York Street Invoice# 00-27355
�
Suite 300 Terms:
W Indianapolis, IN 46204 ~
c Carmel Police Department/CARMEPD
Attn: Pat Young
m 3 Civic Square
Carmel,IN 46032
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee I DescriptionAmount , Balance Due
12/14/15 Striker,Nicholas W Re eat Glucose,Fastin Blood 22.85 $22.8
Venipuncture $3.33 $3.33
Total Charges-> $28:18
Total Payments&Balance Due ? $o.00 $26.1.8
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.
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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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
12/23/15 00-M55 medical tests' $26.18
1110 101
I_hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
:ALLOWED: 20
PUBLIC SAFETY MEDICAL SERVICES
IN SUM OF$
324 E NEW YORK ST SUITE 300
INDIANAPOLIS, IN 46204,1 .
$26.18
ON.ACCOUNT OF .APPROPRIATION FOR
.PO#/.Dept._ INVOICE NO. ACCT#%Fund AMOUNT
Board Members
00-27355 43-407.01 $26.18 I;hereby certify that the attached,invoice(s), or
11.10 _I_ I _ . 101 . I Prior Year
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
-Wednesday, December 30, 2015
Cost distribution ledger classification if,
claim paid motor vehicle.highway fund
'rescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
kn invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by
vhom, 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))
27354 $862.75
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF$
324 East New York Street, Ste. 300
Indianapolis, IN 46204
IV $862.75
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 27354 43-407.01 $862.75 I 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
JAN - 4 2016
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
I
Public Safety Medical - INVOICE
o Public Safety Medical Invoice Date: 12/23/2015
324 E. New York Street Invoice# 00-27354
m Suite 300 Terms: "
tY Indianapolis, IN 46204
c Carmel Fire Department/CARMEFD
H Attn:Asst Chief David Haboush
m 2 Civic Square
Carmel, IN 46032
Exclusively Serving Public Safety Professionals Since 1990.
Date'' Employee` ''' " DescriptionAmount Balance'Due
12/15/15 Thordarson Erik M. PSY-Fit For Duty Psych Eval Initial 862.75 $862.751
Total Charges-> $862.75
Total'Payments&Balance Due->1 $0.00 $862.75
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.
i