HomeMy WebLinkAbout320520 01/11/18 CITY OF CARMEL, INDIANA VENDOR: 00350364
® 3 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $.....**580.52*
CARMEL, INDIANA 46032 24 ENA Y N ST SUITE 300 CHECK NUMBER: 320520
t�roN 46204 CHECK DATE: 01/11118
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 32029 580.52 MEDICAL EXAM FEES
cr_
F5
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 00350364
PUBLIC SAFETY MEDICAL SERVICES IN SUM OF$ CITY OF CARMEL
324 E NEW YORK ST SUITE 300 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.
INDIANAPOLIS, IN 46204
Payee
$580.52
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
32029 43-407.01 $580.52 1 hereby certify that the attached invoice(s),or 1/5/18 32029 $580.52
1120 101 1120 101
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
Friday,January 05,2018
David Haboush
Fire Chief
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Public Safety Medical - INVOICE
oo . Public Safety Medical Invoice Date: 01/04/2018 •
324 E. New York Street Invoice# 00-32029
E'' Suite 300 Terms:
Indianapolis,IN 46204
i
o Carmel Fire Department/CARMEFD
t-- Denise Snyder, Budget&Accred Mgr
m Dsnyder@carmel.In.Gov(B)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee Description Amount Balance Due
12/20/17 Horner.David W nM ro ram 0
Res irator/Medical Review $18.74 $18.74
Health Risk Appraisal Motivation 0.00 $0.00
Com rehensive Physical Exam 114.71 $114.77
Body Fat Test-BIA Bio-Elec Imp Anal 16.40 16.40
Treadmill-Submax $179.11 $179.11
Urinalysis-Dipstick $3.53 $3.53
EKG W/Interp $23.42 $23.42
Audiometry 16.40 $16.40
PFT-Pulmonary Function Test $38.65 $38.65
Vision-Acuity 30.45 $30.45
36tal Sions-HT WT BP P
TSH-Thrid Stim Hormone(Blood) $28.01 $28.01
Venipuncture $3.53 $3.53
Li id Panel Blood 23.82 $23.82
CBC(Comp Blood Count 20.29 $20.29
CMP(Comp Metabolic Panel 22.41 $22.41
PSA-Prostate Specific A Blood 40.99 $40.99
Total Charges-> $580.52
Total Payments&Balance Due-> $0.00 $580.52
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
Michelle McClure at 317-964-2364.