HomeMy WebLinkAbout169127 02/17/2009 I
CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
O 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $333.00
CARMEL, INDIANA 46032
o o INDIANAPOLIS IN 46204 CHECK NUMBER: 169127
CHECK DATE: 2117/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 00 -10517 333.00 MEDICAL EXAM FEES
I
s
INVOICE
o., Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 01/29/2009
m Invoice 00 -10517
LDate Employee Description Amount Balance Due
01123/09 Goodman. Leland C. 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
HIV 1 2 $13.00 $13.00
Quantiferon Tb Gold $50.00 $50.0 0
Strong. David C. 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-OQ $13,00
Quantiferon Tb Gold $50.00 $50.00
White II. Robert E. CMP $16.00 $16.00
CBC WlDiff And Plat $13.00 $13.00
Li id Panel $16.00 $16.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Quantiferon Tb Gold $50.00 3 50.00
Total Charges $333.00
Total Payments &'Balance Due $0.00 $333.00
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 date
Pre ribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995
7;
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.
1
324 E. New York St Terms
Sutie 300
Indpls, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/29/200 00 -10517 a ment for officer physicals 333.00
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
VOI&CHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services IN SUM OF
324 E. New York St
Suite 300
Indpls, IN 46204
333.00
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
D Pr a INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
1110 00 -10517 407 -01 333.00 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
February 11, 2000
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund