167158 12/17/2008 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $573.00
`lo CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 167158
CHECK DATE: 12/17/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 08962 _T 462.00 MEDICAL EXAM FEES
1110 '4340701 10332 111.00 MEDICAL EXAM.FEES
ld
INVOICE
F 0 Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 12/10/2008
Invoice 00 -10332
ate Employee -Description. Amount Balance Due
12/01/08 Keith, Brett A. Exec 1 Wellness $61.00 $61.00
HIV 1 2 $0.00 $0.00
Quantiferon Tb Gold $50.00 $50.00
o alxCharg
Total Payments: &'Balance Due $0.0o $.11;1.00
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 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
Public SAfety Medical Services Purchase Order No.
324 E. New York street, Suite 300 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12110/081 10332 payment for officer physical 111.00
Total
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 NO.
ALLOWED 20
P ublic sAf ety Me Services
IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
111.00
ON ACCOUNT OF APPROPRIATION FOR
police generla fund
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 10332 407 01 111-00 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
December 12 20o8
h 54�
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Public Safety Medical Services, Inc.
324 E. New York ONVONCE
Suite 300 Invoice Number: 00 -08962
Indianapolis, IN 46204 Invoice Date: Nov 24, 2008
TIN 35- 2079797 Page: 1
Voi 1-317-972-1180
Fax: 1- 317 972 -1190
Bit To ta e Ship to x
Carmel Fire Department
2 Civic Square
Carmel, IN 46032
'T
ups'" C
CAR I Net 30 Days
Sales Rep �D x Shipping F Meth b F' ,Ship Date. s 17ue Date
Courier I 12/24
Quantdy Item ric
07 z D se criptton Unit P,e A mount
bra
i
Michael Medlen 12/16/08 Physical (Level 232.00
I OnMed Program .3 10.00
i Treadmill (PFE): 165.00
Funct Move Screen (Pkg) 55.00
I
1
i
i i I i I I
1 Subt 462.00
Sales Tax
Total Invoice Amount 462.0 j
ChecklCredit Memo No:
Paym,en Credit.Applied
TOTAL 6 00
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$462.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1120 08962 43- 407.01 $462.00 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
DEC 15 2006
r n f
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))
08962 Physical $462.00
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