HomeMy WebLinkAbout171048 04/16/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
0 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
CARMEL. INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $497.00
INDIANAPOLIS IN 40204 CHECK NUMBER: 171048
CHECK DATE: 4/16/2009
DEPARTMENT A CCOUNT PO NUMBER I AMOUNT D ESCRIPTION
1110 4340701 00 -10833 257.00 MEDICAL EXAM FEES
1115 .4350900 00 -10877 240.00 OTHER CONT SERVICES
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
a)
X Indianapolis, IN 46204
G Carmel Clay Communications CARMCOM
31 First Avenue NW Terms
Carmel, IN 46032 Invoice Date 0410712009
m Invoice 00 -10877
Date Employee Description Amount Balance Due
04/02/09 Dufek Stephanie R. Audiomet W /Discrimination $65.00 $65.00
Vision Titmus $15.00 15.00
Layton, Matthew E. Audiometry W /Discrimination $65.00 $65.0 0
Vision Titmus $15.00 $15.0 0
Reddick Joshua Audiomet W /Discrimination $65.00 65.00
Vision Titmus $15.DO 15.00
Total Charges $240.00
Total Payments Balance Due $0.00 $240.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 E. New York Street, Ste 300
Indianapolis, In 46204
$240.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE N0. ACCT #(TITLE AMOUNT Board Members
1115 00 -10877 43- 509.00 $240.00 I 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
Monday, April 13, 2009
Director
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))
04/07/09 00 -10877 $240.00
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
INVOICE
Public Safety Medical Services
w 324 E. New York Street
E Suite 300
°m
Indianapolis, IN 46204
Carmel Police Department! CARMEPD
3 Civic Square Terms
m Carmel, IN 46032, Invoice Date 03/3112009
Invoice 00 -10833
Date Employee Description 'Amount 'Balance Due>
03/23/09 Semester, James S. CMP $16.00 $16.00
CBC W /Diff And Plat $13.00 $13.00
Lipid Panel $16.00 $16.00
Veni uncture Fee $3.00 3.00
HIV 1 &2 $13.00 $13.00
Quantiferon Tb Gold $50.00 $50.0 0
03126/09 Foster Johnathan A. CMP $16,00 $16.0 0
CBC W /Diff And Plat 13.00 $13.00
Li id Panel $16.00 $16.00
Veni uncture Fee $3.00 3.00
HIV 1 $13.00 $13.00
Quantiferon Tb Gold $50.00 $50.00
PSA $35.00 $35.00
x
`'Total'Charges ".'$257:00
Total Payments Balance $0:00 $257:00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
r,
PresciVed 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 Medical Services Purchase Order No.
324 E. New York St
Suite 300 Terms
Indpls, IN 46204
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3/31/09 00 -10833 payment for officer physicals 257.00
J. Semester J. Foster
Total
I hereby certify that the attached invoice(s), or bifl(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk Treasurer
�4OUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
JZ4 E. N ew Y ork St IN SUM OF
Suite 300
Indpls, IN 46204
257.00
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 00 -10833 407 -01 257.00 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
Apri 6, 200
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund