HomeMy WebLinkAbout194739 02/16/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $65.00
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 194739
CHECK DATE: 211 612 01 1
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4340700 14481 65.00 MEDICAL FEES
INVOICE �K F IE
MI
0 Public Safety Medical Services J AN 2 8 2011
324 E. New York Street
Suite 300
x Indianapolis, IN 46204 Hy:
o Carmel Clay Parks Recreation 1 CARMELPARK.
1411 E 116th Street Terms
Carmel, IN 46032 Invoice Date 01126!2011
m Invoice 00 -14481
Date Employee Description Amount Balance Due
01/17/11 Morical, Mary (Cindy J. He atibs B Vaccination 43 $65.00 $65.00
Injection Fee $0.00 $0.00
Total Charges $65.00
T ota€ Payments Balance Due $0.00 $65.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from
Invoice date
Purchase
Description �s
P.O.
PorF
G.L.# zf3 7 0 DO
Budget
line Descr S
Purchas
Approval
Date-
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
1126111 14481 Medical fees 65.00
Total 65.00
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
Voucher No. Warrant No.
00350364 Public Safety Medical Services Allowed 20
324 E. New York Street, Ste 300
Indianapolis, IN 46204
In Sum of
t
65.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1091 14481 4340700 65.00 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
10 -Feb 2011
Signature
65.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund