HomeMy WebLinkAbout174008 06/24/2009 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: $368.00
INDIANAPOLIS IN 46204 CHECK NUMBER: 174008
CHECK DATE: 6/24/2009
DEPA ACCOUNT PO NUMBER IN NUMBER AMOUNT DESCRIPTION
41120 4340702 11190 35.00 SHOTS INOCULATIONS
11110 4340701 11191 333.00 MEDICAL EXAM FEES
INVOICE
Public Safety Medical Services
324 E. New York Street
E Suite 300
K� Indianapolis, IN 46204
Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 06!10!2009
m Invoice 00 -11191
Date Employee Description Amount Balance Due
06!01!09 Dunlap, Christopher T. CMP $16.00 $16.00
CBC W1Diff And Plat $13.00 $13.0 0
Lipid Panel 16.00 $16.0 0
Veni uncture Fee $3.00 $3,00
HIV 1 &2 $13.00 $13.00
Quantiferon Tb Gold $50.00 50.00
Harris Sarah E. CMP $16.00 $16.0 0
CBC W /Dill And Plat $13.00 $13.0 0
Lipid Panel $16.00 $16.0 0
Veni uncture Fee 13.00 $3.00
HIV &2 $13.00 $13.
Quantiferon Tb Gold $50.00 $50.00
Malloy Katherine E. CMP $16.00 $16.00
CBC WIDiff 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 13.00
Quantiferon Tb Gold $50.00 $50.0 0
06/03/09 Park Greg A. No -Show Fee 0.00 $0,00
Total Charges $333.00
Total Payments Balance Due $0.00 $333.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
PrescribW by State Board of Accounts City Farm No. 201 (Rev. 1995)
r� 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 Street, Suite 300 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6/10/09 11191 payment 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
VOUCHER NO. WARRANT NO.
ALLOWED 20
R AbliC SafgLy Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
333.00
ON ACCOUNT OF APPROPRIATION FOR
p olice generallfund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 11191 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
June 19 2009
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
o Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
M Carmel, IN 46032 Invoice Date 06110!2009
Invoice 00 -11190
Date Employee Description Amount Balance Due
06/04/09 1 Woodburn Scott E. HB SAb Quantitative Titer $35.00 $35.00
Total Charges $35.00
Total Payments Balance Due $0.00 $35.00
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 East New York Street, Ste. 300
Indianapolis, IN 46204
$35.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 11190 43- 407.02 $35.00 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
-1 1 -IN 2 2 2999
e
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))
11 190 $35.00
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