188488 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
(c ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $205.00
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 188488
CHECK DATE: 8/3/2010
DEPARTMENT ACCOU PO NUMBER I NVOICE NUMBER A MOUNT DESCRIPTION
1125 4340700 13171 180.00 MEDICAL FEES
1125 4340700 13220 25.00 MEDICAL FEES
t
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
Carmel Clay Parks Recreation CARMELPARK
1411 E 116th Street Terms
Carmel, IN 46032 Invoice Date 0612912010
m Invoice 00 -13171
Date Employee Description Amount Balance Due
06124/10 Aleksa John R. Injection Fee $0.00 $0.00
He atitis B Vaccination #1 $65.00 $65,0 0
Baker. Leslie He atitis B Vaccination #1 $65.00 $65.0 0
l6ection Fee 0.00 0.00
Morical Ma (Cindy) J. HB SAb Quantitative Titer $25.00 $25.Od
Zavala Eduardo HB SAb Quantitative Titer $25.00 25.00
Total Charges $180.00
Total Payments Balance Due $0.00 $180.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
Purchase
Description
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Lines
Date.
Purchaser Date
Approval
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INVOICE
F Public Safety Medical Services
324 E. New York Street
E Suite 300
W
m Indianapolis, IN 46204
c� Carmel Clay Parks Recreation I CARMELPARK
1411E 116th Street Terms
Carmel, IN 46032 Invoice Date 0710E12010
m Invoice 00 -13220
Date Employee Description Amount Balance Due
06130110 I Appleman Kali R. HB SAb Quantitative Titer $25.00 $25.00
Total Charges 1 $25.00
Total Payments Balance Due. $0.00 $25.00
Please write invoice number on payirrynt check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
JUL 2 2010
Purchase r�
Description ,.....o oa.00ao.�
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Purchaser Date
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ACCOUNTS PAYABLE VOUCHER.
CITY OF CARMEL
An invoice of 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
Purchase Order No.
00350364 Public Safety Medical Services Terms
324 E. New York Street, Ste 300
Indianapolis, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
61 29110 13171 Drug screens 180.00
718110 13220 Drug screens 25.00
Total 205.00
l 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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
00350364 Public Safety Medical Services Allowed 20
324 E. New York Street, Ste 300
Indianapolis, IN 46204
In Sum of
205.00
ON ACCOUNT OF APPROPRIATION FOR
101 -General
PO# or INVOICE NO. ACCT WTITLE AMOUNT Board Members
Dept
1125 13171 4340700 180.00 1 hereby certify that the attached invoice(s), or
1125 13220 4340700 25.00 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
29 -Jul 2010
Signature
205.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund