HomeMy WebLinkAbout203595 11/09/2011 r CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
f I ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $519.00
INDIANAPOLIS IN 46204
CHECK NUMBER: 203595
CHECK DATE: 11/9/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 16338 519.00 MEDICAL EXAM FEES
INVOICE
F o Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
o Carmel Police Department/ CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 10!3112011
CD Invoice 00 -16338
Date Employee Description Amount Balance Due
10/17/11 Brady, Sean P. CBC (Comp Blood Count 17.68 $17.68
Li id Panel Blood $20.74 $20,74
Veni uncture $3.06 $3.06
HIV 1 2 Blood 13.26 $13.26
CMP (Comp Metabolic Panel 19.52 $19.52
Carey, Luckie A. CMP (Comp Metabolic Panel 19.52 19.52
CBC (Como Blood Count 17.68 $17.68
Li id Panel Blood 20.74 $20.74
Veni uncture $3.06 $3.06
PSA Prostate Specific A Blood 35.70 $35.70
Ca sh. even H. C P (Comp Metabolic Panel) $19.52 $19,52
CBC (Comp Blood Countj $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
Leach Aaron M. Lipid Panel Blood $20.74 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 Blood 13.26 $13.26
CMP (Comp Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 $17.68
Meyer Ryan J. CMP Corn Metabolic Panel 19.52 $19.52
CBC (Como Blood Count 17.68 $17.68
Upid Panel BV 20.74 $20.74
Veni uncture $3.06 $3.06
HIV 1 2 Blood $13.26 $13.26
10/20/11 Zellers Timothy And A. 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
Veni uncture 3.06 $3.06
HIV 1 2 81ood $13.26 13.26
Total Charges $519.00
Total Payments Balance Due $0.00 $519.00
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 date
VOUCHER NO. WARRANT NO.
Public Safety Medical Services ALLOWED 20
IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$519.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1110 16338
I 43- 407.01 I $519.00 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, November 03, 2011
Chief of Police
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))
10/31/11 16338 officer physicals $519.00
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