HomeMy WebLinkAbout178355 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
CHECK AMOUNT: $355.00
CARMEL, INDIANA 46032 324 E NEW YORK Sr SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 178355
CHECK DATE: 10/1412009
DEPARTMENT ACCOUNT PO N UMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 11760 355.00 MEDICAL EXAM! FEES
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
tY Indianapolis, IN 46204
o Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 09/26/2009
Invoice 00 -11760
Date Employee Description Amount Balance Due
09/21/09 Clark Sr. Todd C. CMP $16.00 $16.00
CBC W /Dill And Plat $13.00 $13.0 0
Lipid Panel $16.00 $16.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 &2 $13.00 $13.00
Quantiferon Tb Gold $50.00 $50.0 0
Green Timothy J. CMP $16.00 $16.00
CBC W /Dill And Plat $13.00 $13.0 0
Livid Panel $16.00 $16.0 0
Veni uncture Fee $3.00 $3.00
HIV 13.00
PSA $35.00 $35.00
Quantiferon Tb Gold $50.00 $50.0 0
Jellison Ryan D. CMP $16.00 $16.00
CBC W /Dill And Plat $13.00 $13.00
Lipid Panel $16.00 $16.00
Veni uncture Fee $3.00 $3.00
Quantiferon Tb Gold $50.00 50.00
Total Charges $355.00
Total Payments Balance Due $0.00 $355.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Balance due 15 days from invoice
date
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
r
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))
9/26/09 11760 payment for officer physicals 355.00
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
P ublic Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
355.00
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 11760 407 -01 355.00 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
October S 20 09
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund