HomeMy WebLinkAbout204366 12/06/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $845.40
tif,�•io CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 204366
CHECK DATE: 12/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 16523 845.40 MEDICAL EXAM FEES
INVOICE
F o Public Safety Medical Services
324 E. New York Street
E Suite 300
a)
of Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 11!1812011
m Invoice 00 -16523
Date Employee Description Amount Balance Due
11107/11 Bickel. Joseph E. Quantiferon Tb Blood 51.00 51.00
CMP (Comp Metabolic Pane[ $19.52 $19.52
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
PSA Prostate Specific A Blood 35.70 $35.70
Howard Lana M. CMP Com Metabolic Panel 19.52 $19.52
CBC (Comp Blood Count 17.68 $17.68
Li id Panel Blood 20.74 $20.74
Venipuncture $3.06
HIV 1 2 Blood $13.26 $13.26
Quantiferon Tb Blood 51.00 51.00
Keith Brett A. Quantiferon Tb Blood $51.00 $51.00
CMP (Comp Metabolic Panel M$20.74 19.52
CSC (Comp Blood Count 17.68
Lipid Panel Blood $20.74
Veni uncture 3.06
HIV 1 2 Blood $13.26
McAllister John W. HIV 1 2 Blood 13.26 $13.26
PSA Prostate Specific A Blood 35.70 $35.70
Q uantiferon Tb Blood 51.00 $51.0 0
CMP (Comip Metabolic Pane .52 $19.52
CBC (Comp Blood Count $17.68 $17.68
Lipid Panel Blood $20.74 $20.74
Veni uncture $3.06 $3.06
Schalburg, Randy S. Quantiferon Tb Blood 51.00 $51.O 0
CMP (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
PSA Prostate Specific Ag f Blood 35.70 $35.70
Zellers. Nancy L. Quantiferon Tb Blood 51.00 $51.0 0
P Metabolic Panel) 1 5
CBC (Comp Blood Count $17.68 $17.68
Lipid Panel Blood $20.74 $20.74
Veni uncture $3.06 $3.06
Total Charges $845.40
Total Payments Balance Due $0.00 $845.40
Please write invoice number on payment check.
Balance due 15 days from
Our Federal Employer Identification Number is 35- 2079797 Invoice date
VOUCHER NO. WARRANT NO.
Public Safety Medical Services ALLOWED 20
IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$845.40
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO Dept, INVOICE NO. ACCT /TITLE AMOUNT Board Members
1110 16523 43- 407.01 $845.40 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, December 01, 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))
11/18/11 16523 officer physicals $845.40
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