HomeMy WebLinkAbout184906 04/27/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $463.08
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 184906
CHECK DATE: 4/27/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 12777 463.08 MEDICAL EXAM FEES
INVOICE
Public Safety Medical Services
324 E. New York Street
E Suite 300
X Indianapolis, IN 46204
C Carmel Police Department 1 CARMEPD
F' 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 04114/2010
m Invoice 00 -12777
Date Employee Description Amount Balance Due
04/05/10 Semester, James S. CMP $15.30 $15.30
CBC WlDiff And Plat $12.24 $12.24
Lipid Panel $15.30 115.3 D
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51,00 $51.0 0
PSA $35.70 $35.70
Stein Amy J. CMP $15,30 $15.3 0
CBC WlDiff And Plat $12.24 $12,24
Li id Panel $15.30 $15.30
Veniouncture Fee $3.06 $3.0
HIV 1 &2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
04/08/10 Hood BrVan L. CMP $15.30 $15.30
CBC W /Dill And Plat $12.24 $12.24
Lipid Panel $15.30 $15.3 0
Veni uncture Fee $3,D6 $3,06
Quantiferon Tb Gold $51.00 $51.0 0
Schoeff Jr, Donald D. CMP $15.30 $15.3 0
CBC W /Dill And Plat $12.24 $12.24
Lipid Panel $15.30 $15.3 0
Veni uncture Fee $3,06 $3,06
HIV 1 2 S13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
'Total $463.08
Total Payments &.Balance 'Due $0'00,1 :$463.08'
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
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
Public Safety Medical Services Purchase Order No.
324 E. New York Street, Suite 300 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4/14/10 12777 paygent for officer physidals 463.08
Total
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
P ublic Safety Medical Services IN SUM OF
324 E New York Street, Suite 300
Indianapolis, IN 46204
463.08
ON ACCOUNT OF APPROPRIATION FOR
police generall.fund
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. 1 hereby certify that the attached invoice(s), or
11.10 12777 407 -01 463.08 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
April 23 2 0 10
0 1160 1 7 3v
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund