HomeMy WebLinkAbout197356 05/11/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $1,506.96
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
'cl. INDIANAPOLIS IN 46204 CHECK NUMBER: 197356
CHECK DATE: 5111/2011
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 15016 1,381.70 MEDICAL EXAM FEES
1110 4340701 15061 125.26 MEDICAL EXAM FEES
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
o Indianapolis, IN 46204
C Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 04/27/2011
m Invoice 00 -15016
Date Employee Description Amount Balance Due
04118/11 Collins. Larry J. Quantiferon Tb Blood 51.00 $51.00
CMP Com Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 17.68
Lipid Panel Blood 20.74 20.74
Veni uncture 3.06 $3.G6
HIV 1 2 Blood 13.26 $13.26
Dietz, Aaron K. Quantiferon Tb Blood 51.00 $51.00
CMP (Comip Metabolic Panel 19.52 $19.52
CBC Com Blood Count 17.68 117.68
Livid Pan (Blood) 20.74 S20.74
V
HIV 1 2 Blood $13.26 $13.26
Harting, Charles V. Quantiferon Tb Blood 51.00 51.00
CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 117.68
Lipid Panel Blood 20.74 $20.74
Veni uncture $3.06 $3.06
Pelzer, Robert S. Quantiferon Tb Blood 51.00 $51.00
CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Comip Blood Count 17.68 $17.68
Li id Panel Blood 20.74 20.74
Veni uncture $3-06 $3.06
HIV 1 13.26 $1 3.26
PSA Prostate Specific A Blood $35.70 $35.70
VanNatter, Shane R. Quantiferon Tb Blood $51.00 $51.00
CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 $17.68
Lipid Panel Blood 20.74 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 Blood 13.26 $13.26
04/21/11 Deven ort Adam M. Chart Review /Com letion 182.60 $82.60
Indiana PERF Exam $185.64
Aoolicant Blood Panel PERF $117.10 $117.1 0
Veni uncture $3.06 $3,061
Tb S kin Test $7 $7
Chest X -Ray PA/LAT (Digital) $61.20 $61.20
Drug Screen 7 GC /MS WIMRO $40.80 $40.80
Vital Signs HT WT BP P R $0,00 $0.00
Vision Acuity 26.52 $26.52
Vision Color Ishihara 26.52 $26.52
PFT Pulmonary Function Test $33.66 $33.66
Audiometry 14.28 $14.28
EKG W1 Interp $20.40 $20.40
Urinalysis Dipstick $3.06 $3.06
Tonomet ry (Glaucoma Test) 36.72 1 36.72
04122/11 Hood Brvan L. CMP Corn Metabolic P n 1 19.52 1 .52
INVOICE
Public Safety Medical Services
w 324 E. New York Street
Suite 300
ir Indianapolis, IN 46204
C Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 04127/2011
m Invoice 00 -15016
Date Employee Description Amount Balance Due
CBC (Comip Blood Count 17.68 $17.68
Li id Panel Blood 20.74 $20.74
Veni uncture $3.06 $3.06
V 1 2 (Blood) $13.26 1
Total Charges $1,381.70
Total Payments Balance Due $0.00 $1,381.70
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 3
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$1,381.70
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO, ACCT /TITLE AMOUNT Board Members
1110 15016 43- 407.01 $1,381.70 f hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, May 05, 2011
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by Slate 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))
04/27/11 15016 payment for officer physicals $1,381.70
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
INVOICE
0 Public Safety Medical Services
324 E. New York Street
Suite 300
W Indianapolis, IN 46204
G Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 0510512011
m invoice 00 -15061
Date Employee Description Amount Balance Due
04129/11 Smith Troy D. Quantiferon Tb Blood $51.00 51.00
CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 117.68
Lipid Panel Blood 20.74 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 Blood 13.26 $13.26
Total Charges $125.26
:Total Payments Balance Due $0.00 $125.26
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$125.26
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO Dept_ INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1110 15061 43- 407.01 $125.26 I 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, May 06, 2011
C hi e f of Police
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))
05/05/11 15061 payment for officer physical $125.26
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