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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