HomeMy WebLinkAbout175087 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
CARMEL INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $431.00
'sc INDIANAPOLIS IN 46204
CHECK NUMBER: 175087
CHECK DATE: 7/22/2009
DEPARTMENT ACCOU PO NUMBER INVOI NUMBER AMOUNT DESCRIPTION
'1110 4340701 11356 431.00 METRICAL EXAM FEES
INVOICE
o. Public Safety Medical Services
a 324 E. New York Street
Suite 300
Indianapolis, IN 46204
c Carmel Police Department CARMEPD
t" Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 07/1512003
C3 Invoice 00 -11356
Date Employee Description Amount Balance Due
07106/09 Broadnax. Matthew L. CMP $16.00 $16.00
CBC MDiff And Plat $1100 $13.00
Lipid Panel $16.00 $16.00
Veni uncture Fee $3.00 $3.00
Quantiferon Tb Gold $50.00 S50.0ol
Locke. Robert E. CMP $16.00 16.00
CSC W /Diff And Plat 13.00 $13.00
Lipid Panel 16.00 16.00
Veni uncture Fee 3.00 3.00
Q uantiferon Tb Gold 50.00 50.00
HIV 1 2 13.00 13.00
Morrow. Scott A. CMP $16.00 $16.00
CBC W1DiffAnd Plat $13.00 $1100
Lipid Panel $16.00 $16.00
Veni uncture Fee $3.00 $3.00
Quantiferon Tb Gold $50.00 $50.00
HIV 1 &2 $13.00 $13.00
07109109 Lovitt. Richard A. CMP $16.00 $16,00
CBC W1Diff And Plat 113.00 $13.00
Li id Panel $16.00 S16.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $13.00 S13,0o
Q uantiferon Tb Gold $50.00 $50.00
Total Charges- $431.00
Total Payments Balance Due 30.00 $431 "00
Please write invoice number on payment check.
1
Balance Due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 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
Publics 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))
7/15/09 11356 payment for officer physicals 431.00
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
431.00
ON ACCOUNT OF APPROPRIATION FOR
police general:-
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 11356 407 -01 431.00 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
c
July 17 20 09
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
V 11