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Home My WebLink About204939 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $365.26 a CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 204939 CHECK DATE: 12/2012011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4340700 16581 65.00 MEDICAL FEES 1120 4340701 16738 175.00 MEDICAL EXAM FEES 1110 4340701 16739 125.26 MEDICAL EXAM FEES INVOICE to Public Safety Medical Services 324 E. New York Street E Suite 300 w Indianapolis, IN 46204 o Carmel Clay Parks Recreation CARMELPARK F– 1411 E 116th Street Terms Carmel, IN 46032 Invoice Date 11/29/2011 m Invoice 00 -16581 Date Employee Description Amount Balance Due 11/15/11 Edwards Michael Hepatitis B Vaccination #2 $65.00 $65.00 Injection Fee $0.00 $0.00 Total Charges $65.00 Total Payments Balance Due $0.00 1 $65.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due l5 days from invoice date r,- iption PorF P.O. U0 G.L. I v O Budget h LI;12 D eSCr rwtaJ� _I 1 I Purchaser Approval Date a I 0 5 2011 t/ Vin:... ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 00350364 Public Safety Medical Services Terms 324 E. New York Street, Ste 300 Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 11129111 16581 Medical fees 65.00 Total 65.00 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 1 20 Clerk- Treasurer Voucher No. Warrant No. 00350364 Public Safety Medical Services Allowed 20 324 E. New York Street, Ste 300 Indianapolis, IN 46204 In Sum of 65.00 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1125 16581 4340700 65.00 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 15 -Dec 2011 Signature 65.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE oo Public Safety Medical Services 324 E. New York Street E Suite 300 m it Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 12/1412011 m Invoice 00 -16739 Date Employee Description Amount Balance Due 12/07/11 Smiley, Landry D. 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 Blood 13.26 13.26 Total Charges $125.26 Total Payments Balance Due $0.00 $125.26 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 12/14/11 16739 officer physicals $125.26 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 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $125.26 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 I 16739 I 43- 407.01 I $125.26 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 Friday, December 16, 2011 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 d W Indianapolis, IN 46204 0 Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 12/14/2011 m Invoice 00 -16738 Date Employee Description Amount Balance Due 1 12/05/111 Holubik Steven W. Fitness For Dut Exam Initial Level 2 $175.00 $175.00 Total Charges $175.00 Total Payments Balance Due $0.00 $175.00 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attac in voice(s) or bill(s)) 16738 $175.00 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 N ALLOWED 20 Public Safety Medical Services IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $17 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. I ACCT #/TITLE I AMOUNT Board Members 1120 I 16738 I 43- 407.01 I $175.00 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 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund