156301 02/06/2008 CITY OF CARMEN., INDIANA VENDOR: 00350364 Page 'I of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $625.00
INDIANAPOLIS IN 46204
CHECK NUMBER: 156301
CHECK DATE: 2/612008
DEPARTMENT ACCOUNT PO NUMBER INV OICE NUMBER AMOUNT DESCRIPTION
1110 4340701 8627 625.00 MEDICAL EXAM FEES
INVOICE
ro Public Safety Medical Services
324 E. New York Street
Suite 300
Indianapolis, IN 46204
o Carmel Police Department l CARMEPD
"�7"0 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 01/30/2008
m x Invoice 00 -08627
Date r i K 3 Employee -A--";, Ain unl ;i.Baland6YDue'
01i'21/08 Hobson Phillip L Exec 1 Wellness $61.00 $61.00
HIV $0.00 $0.00
01/22/08 Dewald. GrBqory S. 10 Cities Charge For Blood 295.00 $295.00
Treadmill PI=E 165.00 $165.00
Flexibility Check $7.00 $7,00
Waist/Hi Ratio $0,00 0.0D
01/25/08 Zellers Timothy V. Exec 1 Wellness Offsite $61.00 $61.00
PSA $36.00 36.00
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Total Payments. &:Balance>Diier, 00
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 Medicla 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))
1/30108 8627 a ent for officer physicals 625.00
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
r
P ublic Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, In 46204
625:00
ON ACCOUNT OF APPROPRIATION FOR
p olice general fund
Board Members
Port or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 8627 407 -01 625.00 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
January 31 2008
b 7/
Signature
Chief of Police
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund