HomeMy WebLinkAbout333201 12/11/18 '. CITY OF CARMEL, INDIANA VENDOR: 00350364
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $*******450.30*
CARMEL, INDIANA 46032 6612 E.75TH STREET CHECK NUMBER: 33.3201
SUITE 200 CHECK DATE: 12/11/18
INDIANAPOLIS IN 46250
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 20-34156 450.30 MEDICAL EXAM FEES
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 00350364 IN SUM OF$ CITY OF CARMEL
PUBLIC SAFETY MEDICAL SERVICES
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
$450.30
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
20-34156 43-407.01 $450.30 1 hereby certify that the attached invoice(s),or 11/30/18 20-34156 Physicals $450.30
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
Monday, December 3,2018
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
120-
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Ascension St.Vincent Public Safety Medical - INVOICE
5.
Ascension St.Vincent Invoice Date: 11/28/2018
'"l Public Safe Medical
Safety Invoice# 20,34156
SET 6612.E.75th Street,Suite 200 Terms:
Indianapolis IN 46250
,N%JCarmel Fire Department I CARMEFD
1��(: ; Denise Snyder, Budget&Accred Mgr
roo
Dsnyder a@carmel.ln.Gov(B)
Exclusively Serving Public Safety Professionals Since 9990.
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11/20/18 Brant.-Kenneth o e ' e Physical Exam- 117.07 $117.0
Res irator/Medical Review $19.11 $19.11
OnMed Program $0.00 $0.00
Health Risk Appraisal Medikee er 0.00 $0.00
Hemoccult 0.00 0.00
Med O €n€on-Wellness 0.00 $0.00
Med OplnIon-Resnirator $0.00 00
Med Opinion-Hazmat $0.00 $0,60
Treadmill-Submax $182.69 $182.69
Te t-RIA o-E ec Imp Analy) 16.7
vital Slans-HT WT BP P R $0.00 $0.00
Vision-Amity 3
P -Pulman!lry Functbn
Aud€omet 16.73 16.7
EKG W/Inte 23.69 23.
Urinalysis-Dipstick 3.60 3.60
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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.