157637 03/19/2008 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $906.00
ti; a CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 157637
CHECK DATE: 3/19/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 8807 61.00 MEDICAL EXAM FEES
1110 4340701 8849 845.00 MEDICAL EXAM FEES
INVOICE
4.
o Public Safety Medical Services
324 E. New York Street
:E; Suite 300
a
M IN 46204
Carmel Police Department/ CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 03/05/2008
Invoice 00 -08807
:E;ate 'i "'Employee' "l3escription Amount° ,3 ;Balance Due
02125/08 Henry, David R. Exec 1 Wellness Oftte $61.00 $61.00
HIV $0.00 $0.00
Total Charge's
v TotaGPa'ments'& Balance` Due m> $0:00 er: $61c00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
t
INVOICE
oY' Public Safety Medical Services
324 E. New York Street
E?" Suite 300
Indianapolis, IN 46204
Carmel Police Department 1 CARMEPD
p Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 03/11/2008
Invoice 00 -08849
Employee *''eDescrEption A.• Amou anceDue`.
03 /03 /08 Laker, Jeffrey W. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 $165.00
Flexibility Check $7.00 $7,00
Waist/Hi Ratio $0.00 $0.00
OnMed Program $10.00 $10.00
03/06108 Goodman Leland C. 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
d dtalPayments B:BalanceEDue $0:00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Prescrqed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1985)
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))
3/5/08 8807 payment for officer physical 61.00
3/11/08 8849 payment for officer physicals 845.00
Total 906.00
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
P ublic Safety medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
906.00
ON ACCOUNT OF APPROPRIATION FOR
p olice general fund
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 8807 -01 061.00 bill(s) is (are) true and correct and that the
1110 8849 1 845.00 materials or services itemized thereon for
which charge is made were ordered and
received except
March 14 20o8
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund