HomeMy WebLinkAbout173505 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
o ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $111.00
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204
CHECK NUMBER: 173505
CHECK DATE: 6/10/2009
DEPARTMENT ACCOUNT PO N UMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 11.120 111.00 MEDICAL EXAM FEES
•.a
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
IX Indianapolis, IN 46204
G Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 05/27/2009
m Invoice 00 -11120
Date Employee Description Amount Balance Due
05118109 Bickel Scott W. CMP $16.00 $16.00
CBC W /Dill 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
a
Total Charges $111.00
Total Payments &Balance Due $0,00. $111.00
Please write invoice number on payment check.
Our Federal Employer identification Number is 35- 2079797
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.
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))
5/27/09 11120 payment for officer physical 111.00
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.
a
ALLOWED 20
Pu Dlic Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
111.00
ON ACCOUNT OF APPROPRIATION FOR
police general fu
Board Members
PO# or INVOICE NO. ACCT C'ITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 11120 407 -01 111.00 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 4 20 09
&"A"?
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund