HomeMy WebLinkAbout172503 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $400.00
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
V4, �ONL O.
INDIANAPOLIS IN 45204 CHECK NUMBER: 172503
CHECK DATE: 5/13/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
X 1115 4350900 00 -11025 80.00 OTHER CONT SERVICES
1110 4340701 10984 320.00 MEDICAL EXAM FEES
INVOICE
H Public Safety Medical Services
324 E. New York Street
-i= Suite 300
Indianapolis, IN 462.04
o Carmel Clay Communications 1 CARMCOM
31 First Avenue NW Terms
Carmel, IN 46032 Invoice Date 05/06/2009
Invoice 00 -11025
Date Employee Description Amount Balance Due
04!30109 Paulin Kent Audiomet Wlbiscrimination $65.00 $65.00
Vision Titmus $15.00 $15.0 0
Total Charges $80.00
Total Payments Balance Due $0.00 $80.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
VOUCHER NO. WARRANT NO.
Public Safety Medical Services ALLOWED 20
IN SUM OF
324 E. New York Street, Ste 300
Indianapolis, In 46204
$80.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1115 00 -11025 43- 509.00 $80.00 1 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
Friday, May 08, 2009
Director
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))
05/06109 I 00 -11025 J I $80.00
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
4
INVOICE
Public Safety Medical Services
324 E. New York Street
E Suite 300
v
IX Indianapolis, IN 46204
c Carmel Police Department I CARMEPD
r 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 04/29/2009
0o Invoice 00- 10984
Date Employee Description Amount Balance Due
04/20/09 Case Todd L. CMP $16.00 $16.00
CBC W /Dill And Plat $13,00 $13.00
Lipid Panel $16.00 $16.0 0
Veni uncture Fee $3,00 $3.00
HIV 1 2 $13.00 $13.001
Quantiferon Tb Gold $50.00 $50.00
Flamin Anna G. CMP 16.00 $16.0 0
CBC W1Diff And Plat $13.00 $13.0 0
Lipid Panel $16.00 $16.00
Veniipuncture Fee $3.00 $3.00
Q u a ntif e r o n Tb G $50.00 1 S5 0.00
Schoeff Jr. Donald D. CMP $16.00 $16.00
CBC W /Dill And Plat $13.00 $13.0 0
Lipid Panel $16.00 $16.00
Veni uncture Fee $3.00 $3.00
HIV 1 2 $1.3,00 $13.00
Quantiferon Tb Gold 50.00 $50.00
Total Charges $320.00
Total Payments& Balance Due $0.00 $320.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Presc by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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 Streetr, _Suite 300 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4/29/09 109841:_ payment for officer physicals 320.00
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
P ublic Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
320.00
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 10984 407 -01 320.00 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
i
May 7 20 09
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund