176395 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $9,092.00
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
un `o INDIANAPOLIS IN 46204 CHECK NUMBER: 176395
CHECK DATE: 8/1912009
DEP ARTME NT A CCOUNT PO N INVOICE NUMBER AMOUNT DE
1120 4340701 111454 4,197.00 MEDICAL EXAM FEES
1120 4340701 11455 1,800.00 MEDICAL EXAM FEES
1110 4340701 11456 3,095.00 MEDICAL EXAM FEES
Y:
INVOICE
Fo- Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
c Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/05/2009
m Invoice 00 -11456
Date Employee Description Amount Balance Due
07/27/09 Moore Lindsay Indiana Police /Fire PERF $575.00 $575.00
Chest PA/LAT $55.00 $55.00
Tb Skin Test $0.00 $0.00
Applicant Health Screen PERF $0.00 $0.00
07/28/09 Martin Brian A. Indiana Police /Fire PERF $575.00 $575.00
Chest PA/LAT $55.00 $55.00
Tb Skin Test $0.00 $0.00
Applicant Health Screen PERF $0.00 $0.00
07/29/09 Theis Adam G. Indiana Police /Fire PERF $575.00 $575.00
Tb Review PSMS Given $0.00 $0.00
Aimlicant Health Screen PERF $0.00 $0.0
07/30/09 Cash, Steven H. Indiana Police /Fire PERF $575.00 $575.00
Chest PA/LAT $55.00 $55.00
Applicant Health Screen PERF $0.00 $0.00
Tb Skin Test $0.00 $0.00
07/31/09 Hasty, Zachery R. Indiana Police /Fire PERF $575.00 $575.00
Chest PA/LAT $55.00 $55.0 0
Tb Skin Test $0.00 $0.00
Applicant Health Screen PERF $0.00 $0.00
Total Charges $3,095.00
Total Payments Balance Due $0.00 $3,095.00
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
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.
X 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))
8/5/09 11456 payment for officer physicals 3,095.00
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
Public Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
3,095.00
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 11456 4 -7 -01 3,095.00 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
August 14 20 09
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
G Carmel Fire Department CARMELFD2
f 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/05/2009
0o Invoice 00 -11455
Date Employee Description Amount Balance Due
07/29/09 Collins Tony A. PSA $35.00 $35.00
Dorsch James E. PSA $35.00 $35.00
Drake. Carl D. PSA $35.00 $35.0 0
Fuchs Jeffery W. RBC Cholinesterase $45.00 $45.00
Giles William G. RBC Cholinesterase $45.00 $45.00
Holden Adam D. PSA $35.00 $35.00
Holubik Steven W. RBC Cholinesterase $45.00 $45.0 0
Horner David W. PSA $35.00 $35.0 0
Howard Wendell E. PSA $35.00 $35.0 0
Keaton Anthony R. RBC Cholinesterase $45.00 $45.00
Ki lburn, RoQer L. PSA $35.
Lux Michael T. PSA $35.00 $35.00
Price Joseph P. RBC Cholinesterase $45.00 $45.00
Reynolds, Shawn J. PSA $35.00 $35.00
Small Thomas D. PSA $35.00 $35.00
Stindle Kevin P. RBC Cholinesterase $45.00 $45.0 0
Voskuhl Mark J. RBC Cholinesterase $45.00 $45.0 0
Workman William J. PSA $35.00 $35.00
07/30/09 Baskerville Steven P. PSA $35.00 $35.00
Bondurant Jeff S. PSA $35.00 $35.00
Brant Kenneth E. PSA $35.00 $35.00
Brisco Michael D. PSA $35.00 $35.00
Cox Justin M. RBC Cholinesterase $45.00 $45.00
Davis, James M. PSA $35.00 $35.00
Haboush David G. RBC Cholinesterase $45.00 $45.00
Haymaker, Samuel K. PSA $35.00 $35.0 0
Marcum. Bradley D. RBC Cholinesterase $45.00 $45.00
Martin David D. PSA $35.00 $35.00
Martin Richard A. PSA $35.00 $35.0 0
Osborne Scott K. PSA $35.00 35.00
Weaver Virgil L. PSA $35.00 $35.00
07/31/09 Callahan Mark PSA $35.00 $35.0 0
Crane Barry L. PSA $35.00 $35.0 0
Crisler, John H. PSA $35.00 $35.0
Fisher Gary L. PSA $35.00 $35.00
Foster, James P. PSA $35.00 $35.00
RBC Cholinesterase $45.00 $45.00
Grimes, Jeffrey A. PSA $35.00 $35.00
Kelsheimer Troy W. RBC Cholinesterase $45.00 $45.00
Love Joseph B. PSA $35.00 $35.00
Mead Jr. Donald R. PSA $35.00 $35.0 0
Medlen Michael J. PSA $35.00 $35.0 0
Philli s Craia M. PSA $35.00 $35.0 0
Reeves Stephen J. PSA $35.00 $35.00
SiAbring. James E. PSA $35.00 $35.00
Steele Jeffrey A. PSA $35.00 $35.00
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
C Carmel Fire Department/ CARMELFD2
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/05/2009
m Invoice 00 -11455
Date Employee Description Amount Balance Due
VanVoorst Robert J. PSA $35.00 35.00
Viehe Richard E. PSA 35.00 35.00
Total Charges $1,800.00
Total Payments Balance Due 1 $0.00 $1,800.00
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 date
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
iX Indianapolis, IN 46204
C Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/05/2009
m Invoice 00 -11454
Date Employee Description Amount Balance Due
07/29/09 Alverson Jonathon L. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Benbow, Kip S. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.0 0
HIV 1 2 $13.00 $13.00
ttl r James N. CMP $15.
CBC W /DiffAnd Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
Collins Tony A. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
Contino David M. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 13.00
Dorsch, James E. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Drake Carl D. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.0 0
HIV 1 2 $13.00 $13.0 0
Frye, Steven R. $15.00 $15.0 0
CB W/Diff And Plat $12.00 12.
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Holden Adam D. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Horner David W. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 12.00
Lipid Panel $15.00 $15.00
INVOICE
oo Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
C Carmel Fire Department CARMEFD
F- Terms
2 Civic Square
Carmel, IN 46032 Invoice Date 08105/2009
m Invoice 00 -11454
Date Employee Description Amount Balance Due
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.001
Howard Wendell E. CMP $15.00 $15.0 0
CBC W Diff And PI at $12.00 $12.
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Hughes, Chad L. CMP $15.00 $15.00
CBC W /Diff And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Kilburn Roger L. CMP $15.00 $15.00
CBC W /Diff And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
HB SAb Quantitative Titer $35.00 $35.00
Lux Michael T. CMP $15.00 $15.00
CBC W /Diff And Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Orange, Douglas D. CMP $15.00 $15.0 0
CBC W /Diff And Plat $12.00 $12.0 0
Li id Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00,
HIV 1 2 $13.00 $13.
Ray, Lucas M. CMP $15.00 $15.00
CBC W /Diff And Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Blood Type $22.00 $22.0 0
Reeves Neil P. CMP $15.00 $15.0 0
CBC W /Diff And Plat $12.00 $12.0 0
Lipid Panel $15.00 15.00
Veni uncture Fee $3.00 $3.00
13.0 $13.0
Reynolds, Shawn J. CMP $15,00 $15.00
CBC W /Diff And Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Small Thomas D. CMP $15.00 $15.0 0
CBC W /Diff And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.00
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Fire Department CARMEFD
F 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/05/2009
m Invoice 00 -11454
Date Employee Description Amount Balance Due
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Stindle Kevin P. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.00
Li id Panel $15.00 $15.001
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Utzig, Chad M. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.0 0
Li id Panel $15.00 15.00
Veniouncture F e $3.00 $3,00
HIV 1 2 $13.00 $13.00
Utziq, Todd T. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 &2 $13.00 $13.00
Watts. Trent E. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
B lood T 2.00 $22,0
Workman, William J. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 3.00
HIV 1 &2 $13.00 $13.0 0
Wynn, Barbara M. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Young, Kevin M. MP $15.00 $15
B W Diff And P lat $12.00 $12.0
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Blood Type $22.00 $22.00
Zeller Michael J. CMP $15.00 $15.0 0
CBC W /Diff And Plat $12.00 $12.00
Lipid Panel $15.00 $15.001
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
HB SAb Quantitative Titer $35.00 $35.00
07/30/09 Bailey, Mark E. CMP $15.00 $15.00
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
G Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/05/2009
m Invoice 00 -11454
Date Employee Description Amount Balance Due
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 15.00
Veni uncture Fee $3.00 $3.00
V 1 $13.00 $13.0
Baskerville, Steven P. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Bondurant Jeff S. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 &2 $13.00 $13.0 0
Brant Kenneth E. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Brisco Michael D. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Condra Kyle E. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veniouncture Fee $3.00 $3,0
HIV 1 &2 $13.00 $13.00
Davis, James M. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.001
HIV 1 2 $13.00 $13.00
Haymaker, Samuel K. MID $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 $13.00 13.0
Martin, avid GMP $15,00 $15.0
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 3.00
HIV 1 2 $13.00 $13.00
Martin Richard A. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
INVOICE
oo Public Safety Medical Services
324 E. New York Street
E Suite 300
X Indianapolis, IN 46204
o Carmel Fire Department CARMEFD
F 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08105/2009
m Invoice 00 -11454
Date Employee Description Amount Balance Due
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Mason Bryan L. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Li id Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 &2 $13.00 $13.0 0
Blood Type $22.00 $22.0 0
McNeely, Michael W. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.00
Lio id Panel $15.00 $15
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Osborne Scott K. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Peterson Vernon A. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $1
Smith, Brian E. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Weaver Virgil L. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.001
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
07/31/09 Allen Brad A. CMP $15.00 $15.
CBC W iff And Plat $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Butts, Renee L. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Li id Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
Callahan Mark CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
INVOICE
Fro Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
C Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/05/2009
m Invoice 00 -11454
Date Employee Description Amount Balance Due
HIV 1 2 $13.00 $13.00
Crane Barry L. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.0 0
Lir) Panel $15.00 $15,0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Crisler, John H. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Fisher Gary L. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Foster James P. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 15.00
Veni uncture Fee 3.00 $3.00
HIV 1 &2 $13.00 13.00
Griffin Timoth M. CMP 15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Grimes Jeffrey A. CMP $15.00 $15.00
CB W Diff And Plat $12.00 1 $12.0(
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Haus Joshua S. CMP $15.00 $15.0 0
CBC W /Diff And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.0 0
HIV 1 2 $13.00 13.00
Blood Type $22.00 $22.0 0
Kelsheimer, Troy W. CMP $15.00 $15.00
CBC iff And Plat $12.00 $12.0 0
Lio id Panel $15,00 $15.0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Love Joseph B. CMP $15.00 $15.00
CBC W /Diff And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
tY Indianapolis, IN 46204
C Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08!0512009
E Invoice 00 -11454
Date Employee Description Amount Balance Due
Mead Jr. Donald R. CMP $15.00 $15.00
CBC W /Dill And Plat $12,OD 12.00
1-10d Panel $15.00 $15.0 0
Veni uncture Fee $3,00 $3.DO
HIV 1 2 $13.00 $13.00
Medlen Michael J. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.0 0
Veni uncture Fee S3.00 $3.0 0
HIV 1 2 $13.00 $13.00
Miller, Scott G. CMP 1 $15,()
CBC W /DiffAnd Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 &2 13.00 $13.001
Mitchell James C. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.OD $12.DO
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 13.00
HIV 1 2 1100 $13.0 0
Pa ne Thomas C. CMP $15,DO S15M
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 &2 $13.00 $13.00
Phillips. Craig M. CMP $15.00 $15,00
CBC W /DiffAnd Plat $12,00 $12.00
Li id Panel $15.00 $15.00
Veni uncture Fee 3.00 $3.00
HIV 1 2 $13.00 $13.0 0
Reeves. Stephen J. CMP $15.00 $15.00
CBC W /Dill And Plat $12,00 $12.0 0
Lipid Panel $15.00 $15.0 0
V n n t r F $3.00 $3.
HIV 1& 2 $13.00 1
Reppert, Ian T. CMP $15.00 $15.00
CBC W /DiffAnd Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
HIV 1 &2 $13.00 $13.0 0
Robinson Mitchell L. CMP $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.OD $3.00
HIV 1 2 13.00 $13.00
Rohr Christopher M. I CMP 15.00 $15.001
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
G Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/05/2009
m Invoice 00 -11454
Date Employee Description Amount Balance Due
CBC W /DiffAnd Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
IV 1 2 $13.00 $13.0 0
S elbrin James E. MID $15.00 $15.00
CBC W /DiffAnd Plat $12.00 $12.00
Lipid Panel $15.00 $15.00
Veni uncture Fee $3.00 $3.00
Steele Jeffrey A. CMP $15.00 $15.0 0
CBC W /Dill And Plat $12.00 $12.0 0
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
VanVoorst Robert J. MID $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 $13.00
Viehe Richard E. MID $15.00 $15.00
CBC W /Dill And Plat $12.00 $12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 &2 $13.00 $13.0 0
Woodburn Scott E. MID $15.00 $15.001
CBC W /Dill And Plat $12.00 12.00
Lipid Panel $15.00 $15.0 0
Veni uncture Fee $3.00 $3.0 0
HIV 1 2 $13.00 $13.0 0
Blood Type 1 $22.00 $22.
Total Charges $4,197.00
Total Payments &Balance Due $0.00 $4,197.00
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$5,997.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1120 11454 43- 407.01 $4,197.00 1 hereby certify that the attached invoice(s), or
1120 11455 43- 407.01 $1,800.00 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
AUG 17 2009
Fire Chief
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))
11454 $4,197.00
11455 $1,800.00
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