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Home My WebLink About255302 02/09/16 � CITY OF CARMEL, INDIANA VENDOR: 00350364 ® ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $"" "1,482.90" CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 255302 INDIANAPOLIS IN 46204 CHECK DATE: 02/09/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 R4341999 33237 11-10887 1,482.90 PHYSICALS VOUCHER NO. WARRANT NO. ALLOWED 20 PUBLIC SAFETY MEDICAL SERVICES 324 E NEW YORK ST SUITE 300 IN SUM OF$ INDIANAPOLIS, IN 46204. $1,482.90 ON ACCOUNT OF APPROPRIATION FOR Carmel Police. _6i/.Dept. INVOICE NO. ACCT#%Fund AMOUNT Board Member: 633237 11-10867 43-419.99 $1,482.90 1 hereby certify that the attached invoice(s), or 1110 Encumbered 101 . 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 Tuesday, February 02, 2.016 Cost distribution ledger classification if claim paid motor vehicle highway fund- Public Safety Medical Services, Inc. MILEIVOIAWAOM 324 E.New York I N UL Suite 300 Invoice Number. 11-10867 Indianapolis,IN 46204 Invoice Date: Nov 10,2015 TIN 35-2079797 Page: Voice: 1-317-972-1180 Fax: 1-317-972-1190 Carmel Police Department Carmel Police Department 3 Civic Square 3 Civic Square Carmel, IN 46032 Carmel,IN 46032 ... ...... CARMEPD Net 15 Days Courier 1125/16 -------------------- December 10,2015_applicant#1 Chart 89.85 Review/Completion Indiana PERF Exam 201.90 Drug Screen(9)+Opiates&Oxycodone 44.38 Tonometry(Glaucoma Test) 39.94 Urinalysis-Dipstick 3.33 EKG WA nterp 22.18 Audiometry 15.54 PFT-Pulmonary Function Test 36.61 Vision-Color(Ishihara) 28,84 Vision-Acuity 28.84 Vital Signs-HT WT BP P R Applicant Blood Panel-PERF 127.38 Th Skin Test 7.77 Chest X-ray-PAILAT(Digital) 66.56 Venipuncture 3.33 Respirator Clearance SS 25-00 December 10,2015 appiicant#2 Chart 89.85 Review/Completion Indiana PERF Exam 201.90 Drug Screen(9)+Opiates&Oxycodone 44.38 Subtotal Continued Sales Tax Continued Total Invoice Amount Continued Check]Credk Memo No: Payment/Credit Applied Public Safety Medical Services, Inc. U sAft ARbLOM 324 E. New York Suite 300 Invoice Number: 11-10867 Indianapolis, IN 46204 Invoice Date: Nov 10, 2015 TIN 35-2079797 Page: 2 Voice: 1-317-972-1180 Fax: 1-317-972-1190 -KIN .3- .. . ...... 4-M—A—Ma; Carmel Police Department Carmel Police Department 3 Civic Square 3 Civic Square Carmel, IN 46032 Carmel, IN 46032 CARMEPD 21'171- Net 15 Days FRi -.44 th"Pu-.1 Courier 11125/15 Tonometry(Glaucoma Test) 39.94 Urinalysis-Dipstick 3.33 EKG W/Interp 22.18 Audiometry 16.54 PFT-Pulmonary Function Test 36.61 Vision-Color(Ishihara) 28-84 Vision-Acuity 28.84 Vital Signs-HT WT BP P R Applicant Blood Panel-PERF 127.38 Th Skin Test 7.77 Chest X-ray-PA/LAT(Digital) 66.56 Venipuncture 3.33 Respirator Clearance SS 25.00 Subtotal 1,482.90 Sales Tax Total Invoice Amount 1,482.90 Check/Credit Memo No: Payment/Credit Applied Y_ INDIANA RETAIL TAX EXEMPT PAGE City ®f Carm. e� CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 33237 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/ CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIP, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 SHIPPING LABELS AND ANY CORRESPONDENCE JRCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION Public Safety Nledlcal Servicos Carmol Police Department VENDOR SHIP 3 Civic Squaru 324 E. Now Vork m(A, SuKo 300 TO Carmel, IN � �� IndlanapoIlS, IN 46204 (3 1)571-2559 'ONFIRMAl10N BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION '►ccount 43499.09 2 Each physical f®r applicant $749.46 $9,482.90 Sub Total: $1,482.00 5 .:'!/> Send Send Invoice To: r� Gabriel Pollee Dep2itment Attn: Pa Young 3 Civic Squaw Camel, IN 46M2- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT arrnel Police Dept. X11, 2.W PAYMENT • A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. I HEREBY CERTIFY SHIPPING INSTRUCTIONS Y THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION SHIP REPAID. SUFFICIENT TO PAY FOR THE ABOVE ORDER. • •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY L✓'/rif •PURCHASE ORDER NUMBER MUST APPEAR ON ALL j�N� SHIPPING LABELS. /giprl0f of Police •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE / AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK-TREASURER DOCUMENT CONTROL NO. 3 3 2 3 7 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE