HomeMy WebLinkAbout333019 12/11/18 Coq
® � CITY OF CARMEL, INDIANA VENDOR: 372939
• ONE CIVIC SQUARE ASCENSION ST VINCENT PUBLIC SAFEI%4ECK AMOUNT: $.....**280.80*
CARMEL, INDIANA 46032 6612 E 75TH STREET CHECK NUMBER: 333019
SUITE 200 CHECK DATE: 12/11/18
`TSN`O INDIANAPOLIS IN 46250
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 20-34157 140.40 MEDICAL EXAM FEES
1110 4340701 2034195 140.40 MEDICAL EXAM FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 372939 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ASCENSION ST VINCENT PUBLIC SAFETY IN SUM OF$ CITY OF CARMEL
6612 E 75TH STREET An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
SUITE 200 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46250
Payee
$140.40
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police 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
20-34195 43-407.01 $140.40 1 hereby certify that the attached invoice(s),or 12/4/18 20-34195 officer physicals $140.40
1110 101 1110 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
Monday, December 10,2018
Jim Barlow
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
Ascension St. Vincent 'Public,Safety Medical - INVOICE
McOnsion St.Vincent Invoice Date: 121/04/2018
Public Safety Medical Invoice# 20-34195
E 6612 E.75th Street,Suite 200
Terms:
w Indianapolis IN 46250
Carmel Police Department./CARIVIEPD
0
16- Pyoung@carmel.1n.Gov(W)
Exclusively Serving Public Safety Profess.i.onals Since 1990.,
Date _Employee Description Amount- Balance Due
11/30/18 Myers,Brady R. HIV-.4th Gen Rar)id Test(Blood) $26.58 $26.5
Venlouncture $3.62 $3.62
Li id Panel Blood $24.42 :$24.42
CBC(Comp BI I ood Count) $20.80 $20.8
CMP(Comp Metabolic-Panel 22.97 $22.9
P-RA.-Prostate specific Ao(Blood) 1 j42.01: 1 42.01'
Total $140.40
Total Payments&Balah66bipe'-_> '$0.00
Please make check,payable to"Ascension cer,sion St.Vincent Public SafetyMedical"and write invoice number on payment
check. Our Federal Employer identification number is 46-1227327
We-greatly appreciate the opportunity to serve you. If you have any questi6ris regarding this invoice, please contact
Michelle McClure at 817-;964-23,64.
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 372939 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ASCENSION ST VINCENT PUBLIC SAFETY IN SUM OF$ CITY OF CARMEL
6612 E 75TH STREET An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
SUITE 200 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46250
Payee
$140.40
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Carmel Police 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
20-34157 43-407.01 $140.40 1 hereby certify that the attached invoice(s),or 11/28/18 20-34157 officer physicals $140.40
1110 101 1110 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
Tuesday, December 4,2018
Jim Barlow
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
Ascension St. Vincent Public Safety Medical - INVOICE
H Ascension St:-Vincent Invoice Date: 11/28/2018,.
Public Safety Medical Invoice# 20-34157
E 6612E.75th Street,Suite 200 Terms:
:�. Indianapolis IN 46250
c .Carmel Police Department/CARMEPD
h- Pyoung@carmel:In.Gov'-(W)
-DO ,
Exclusively Serving Public Safety Professionals Since 1990..
"-'DafeZrnployee, D_escHptlon; Amount- Balance_Due_
Keift B t $Vehhjundure
4t Gen Rapid Test B 26 S
$162 $162
Panel Blood 24,42 24.4CBCCom Blood Count *20;80 20.80
CMR Com`Metabolic Panel 22.97
PSA-Prostate S ecific A Blood 42.01
Total Cfiarges;=3 .. $.140.40 '• -.
Total Payments,&Balance Due >.. $0 Og' $140:40
Please.make check payable.to"Ascension St.Vincent Public Safety Medical'and write invoice number on payment
check. Our Federal Employer identification number is 46-1227327.
We greatly appreciate the opportunity to serve you. If you have any questions regarding.this invoice, please contact
Michelle McClure at 317-964-2364.