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Home My WebLink About199162 07/06/2011 e. CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $552.78 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 •s,. INDIANAPOLIS IN 46204 CHECK NUMBER: 199162 CHECK DATE: 7/6/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4340700 15313 65.00 MEDICAL FEES 1110 4340701 15358 125.26 MEDICAL EXAM FEES 1110 4340701 15425 237.26 MEDICAL EXAM FEES 1110 4340701 15483 125.26 MEDICAL EXAM FEES INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 a) W Indianapolis, IN 46204 C Carmel Police Department CARMEPD h 3 Civic Square Terms Carmel, IN 46032 Invoice Date 06/15/2011 M Invoice 00 -15358 Date Employee Description Amount Balance Due 06/06/11 Jent. Danny N. 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 Ed Veni uncture $3.06 $3.06 HIV 1 8 2 Blood 13.26 S13,26 Total Charges 1 $125.26 total Payments Balance Due y $0:00 $125.26 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date INVOICE F Public Safety Medical Services 324 E. New York Street E Suite 300 z Indianapolis, IN 46204 c Carmel Police Department CARMEPD H Terms 3 Civic Square Carmel, IN 46032 Invoice Date 06122!2411 Invoice 00 -15425 Date Employee Description Amount Balance Due 06113/11 Semester James S. Quantiferon Tb Blood 51.00 51.00 CMP (Comp Metabolic Panel 19.52 $19.52 CBC Com p 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 06/15/11 Martin Brian A. Quantiferon Tb Blood 51.00 51.00 CMP (Comp Metabolic Panel 19.52 $19.52 CBC (Como Blood Count 17.68 17.68 Li id Panel Blood 20.74 20.74 Ve To Charges $237.26 Total Payments Balance Due $0.00 $237,26 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due ]S 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 06/15/11 15358 payment for officer physicals $125.26 06/22/11 15425 payment for officer physicals $237.26 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 N ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $362.52 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 15358 43- 407.01 $125.26 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 15425 43- 407.01 $237.26 materials or services itemized thereon for which charge is made were ordered and received except Wednesday, June 29, 2011 C hi e f of Pol Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE a Public Safety Medical Services 324 E. New York Street E Suite 300 IY Indianapolis, IN 46204 O Carmel Clay Parks Recreation CARMELPARK 1411E 116th Street Terms Carmel, IN 46032 Invoice Date 06/08/2011 00 Invoice 00 -15313 Date Employee Description Amount Balance Due 06/03111 Jones Joshua Hepatitis B Vaccination #3 $65.00 $65.00 In ection Fee $0.00 $0.00 Total Charges $65.00 Total Payments Balance Due $0.00 $65.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date Purchase Description th+ P.O. P or F G.L. I Li 7 5 Budoet 1 -me Descr Purchaser 0_�_ Date BY. Approvals 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 PO Amount Date Number (or note attached invoice(s) or bill(s)) 65.00 6/8/11 15313 Hep B vaccine Total 65.00 is (are) true and correct and I have audited same in accordance I hereby certify that the attached invoice(s), or bill(s) 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 65.00 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1125 15313 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 28 -Jun 2011 P Signature 65.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE 0 Public Safety Medical Services 324 E. New York Street Suite 300 of Indianapolis, IN 46204 G Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 06/28/2011 m Invoice 00 -15483 Date Employee Description Amount Balance Due 06/20111 Renforth Trevor M. Quantiferon Tb Blood $51.00 $51,0 0 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 (Blodl $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 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 Purchase Order No. Terms Date Due invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 06/28/11 15483 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 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 15483 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, July 01, 2011 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund