HomeMy WebLinkAbout193203 12/22/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
0 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $2,354.34
S4a CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 193203
CHECK DATE: 12122/20'10
DEPA ACCOUNT PO NUMBER I NVOICE NUMBER AM OUNT DESCRIPTION
1110 4340701 27011 14176 2,354.34 CONTRACT PAYMENTS
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
d
x Indianapolis, IN 46204
o Carmel Police Department/ CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 12I06I2010
m Invoice 00 -14176
Date Employee Description Amount Balance Due
12/02/10 Batic.ZacharyJ. Indiana Police /Fire PERF $178.50 $178.50
Chart Review/Completion 52.00 52.00
Chest PA/LAT $61.20 $61.2 0
Tb Skin Test $7.14 $7.14
Applicant Health Screen PERF $120.16 $120.16
Drug Screen 7 GC/MS WIMRO $71.40 $71.40
Hemoglobin A1C $60.00 $60.00
Color Vision Farnsworth 26.52 26.52
Vital Si ns HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
Colo Vis on Oshihara) $26.52 S25.52
PFT W/Interp $33.66 $33.66
Audiometry $14,28 $14.28
ECG W1 Interp $20.4G $20.4 0
Urinalysis Dipstick 3.06 $3.061
Tonometry $36.72 36.72
Buckingham, John D. Indiana Police /Fire PERF $178.50 $178.50
Chart Review/Completion $52.00 52.00
Chest PA/LAT $61.20 $61.20
Tb Skin Test $7.14 $7.14
Aoylicant Health Screen PERF $120.16 $120.16
Drug Screen 7 GC/MS INIMRO $71.40 $71.40
P 7 1
Vision Titmus $26.52 $26.52
Color Vision Ishihara $26.52 $25.52
PFT W/Interp $33.66 $33.66
Audiometry 14.28 $14.28
ECG W/ Interp 120.40 $20.4 0
Urinalysis Dipstick $3.06 $3.06
Tonometry $36.72 $36.72
Giber', William CMP $15.30 $15.3d
CBC WlDiff And Plat $12.24 12.24
Lipid Panel $15.30 $15.30
Veni uncture Fee $3.06 $3.06
IV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
HB SAb Quantitative Titer $35.70 $35.70
Leach Aaron M. CMP $15.30 $15.3 0
CBC WlDiff And Plat $12.24 $12.24
Livid Panel $15.30 $15.30
Veni uncture Fee 3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.0 0
HB SAb Quantitative Titer $35.70 $35.70
12/03/10 Koebcke Chad E. Indiana Police /Fire PERF $178.50 $178.50
Chart Review /Com letion $52.00 $52.0 0
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 12106/2010
m Invoice 00 -14176
Date Employee Description Amount Balance Due
Chest PAILAT $61.20 $61.20
Tb Skin Test $7.14 $7.141
Apolioarit Health Screen PERF $120.16 120.16
Drua Screen 7 GC M W/MRO $71.40 71.4
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
Color Vision Ishihara $26.52 $26.52
PFT W/Interp $33.66 $33.661
Audiometry 14.28 $14.28
ECG W/ Interp $20,40 $20.4 0
Urinal sis Dipstick 3.06 $3.06
Tonometry $36.72 $36.72
Total Charges $2,354.34
Total Payments Balance Due $0.00 $2,354.34
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$2,354.34
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
27011 14176 43- 407.01 $2,354.34 1 hereby certify that the attached invoice(s), or
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, December 17, 2010
C hi e f o f P
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/06/10 14176 payment for officer and applicant physicals $2,354.34
1 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