160034 05/28/2008 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $942.00
INDIANAPOLIS IN 46204
CHECK NUMBER: 160034
CHECK DATE: 5/2812008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 R4350900 16554 00 -09226 80.00 HEALTH SCREEN EVALUAT
1 110 4340701 9179 429.00 MEDICAL EXAM FEES
1110 4340701 9227 433.00 MEDICAL EXAM FEES
INVOICE
Public Safety Medical Services
324 E. New York Street
E' Suite 300
{Y Indianapolis, IN 46204
o, Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 05/21/2008
m Invoice 00 -09227
:Date Employee Description Amount Balance Due=
05/12/08 Bodenhorn. Wendv M. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Quantiferon Tb Gold $50.00 $50.00
Carpenter. Janet L. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
Quantiferon Tb Gold $50.00 $50.0 0
Elliott. John R. Quantiferon Tb Gold $50.00 $50.0 0
Towle John R. Quantiferon Tb Gold $50.00 $50.00
VanNatter, Shane R. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV 0.00 $0.00
Q uantiferon Tb Gold $50.00 $50.0
Total`Charg es $433.00
Total Payments Balance Due $0:00 $433.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
o" Public Safety Medical Services
324 E. New York Street
Suite 300
Indianapolis, IN 46204
,o Carmel Police Department CARMEPD
f 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 05/13/2008
m Invoice 00 -09179
Date Employee Description Amount 'Balance Due
05/07/08 Dietz, Aaron K. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 $165.00
Body Fat Check Bod Pod $23.00 $23.0 0
Flexibility Check $7.00 $7.00
Waist/Hi Ratio $0.00 $0.00
`Total Charges $429:00
fl 7 ^Total:Pzyments8Balance.Due $0:00 `$429100}
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
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))
5/13/08 9179 payment for officer physical 429.00
5/21/08 9227 payment for officer physicals 433.00
Total 862.00
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.
ALLOWED 20
Pul lic Safety Medical Services IN SUM OF
324 E. New York street, Suite 300
Indianaoplis, IN 46204
862.00
ON ACCOUNT OF APPROPRIATION FOR
police generalf and
Board Members
INVOICE NO. ACCT #/TITLE AMOUNT
DEPT I hereby certify that the attached invoice(s), or
1110 9179 407 -01 429.00 bill(s) is (are) true and correct and that the
1110 9227 407 -01 433.00 materials or services itemized thereon for
which charge is made were ordered and
received except
Ma 1 20 08
X '!Z�L
Si
Ass.is ant Chief of Polic
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
INVOICE
o' Public Safety Medical Services
324 E. New York Street
.:E Suite 300
r
Indianapolis, IN 46204
Carmel Clay Communications 1 CARMCOM
1- j 31 First Avenue NW Terms
`Y
Carmel, IN 46032 Invoice Date 05/21/2008
=[n Invoice 00 -09226
Date Employee :Description :'Amount.` BalanceDuei;
05/14/08 Phillips, Kerry N. Vision Titmus $16.00 $16.00
Audiometry WlDiscrimination $64.00 S64.00
Total ^charges, 80:00,
Total Payments &Balance "Due $80:00'
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, Ste 300
Indianapolis, In 46204
$80.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
16554 00 -09226 43- 509.00 $80.00 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
Thursday, May 22, 2008
Director
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))
05/21/08 I 00 -09226 I I $80.00
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