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Home My WebLink About206785 02/28/2012 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: $601.60 INDIANAPOLIS IN 46204 CHECK NUMBER: 206785 CHECK DATE: 2/2812012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4340700 17196 65.00 MEDICAL FEES 1110 4340701 17197 536.60 MEDICAL EXAM FEES INVOICE H Public Safety Medical Services 324 E. New York Street Suite 300 tY Indianapolis, IN 46204 C Carmel Clay Parks Recreation CARMELPARK 1411E 116th Street Terms Carmel, IN 46032 Invoice Date 02/16/2012 m Invoice 00 -17196 Date Employee Description Amount Balance Due 02/06/12 Edwards Michael Hepatitis B Vaccination #3 $65.00 $65.00 Injection Fee $0.00 $0.00 Total Charges $65.00 Total Payments Balance Due $0.00 1 $65.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date Purchase n Q S Description 1 Vv D LOS P.O. P or F FEB 2 1 2012 3 yo70o Budget Line Descr C ate Z /Z I r Z BY: Purchaser Approval Date ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. 00350364 Public Safety Medical Services Terms 324 E. New York Street, Ste 300 Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 2/16/12 17196 Medical fees 65.00 Total 65.00 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20_ Clerk- Treasurer Voucher No. Warrant No. 00350364 Public Safety Medical Services Allowed 20 324 E. New York Street, Ste 300 Indianapolis, IN 46204 In Sum of$, 65.00 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. A CCT #/TITLE AMOUNT Board Members Dept 1125 17196 4340700 65.00 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 23 -Feb 2012 Signature 65.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02/16/2012 m Invoice 00 -17197 Date Employee Description Amount Balance Due 02/06/12 Bodenhorn, Wendy M. Quantiferon Tb Blood $52.28 $52.28 CMP (Comp Metabolic Panel 20.01 $20.01 CBC (Comp Blood Count 18.12 $18.1 2 Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 Moore. Scott L. CBC Com p Blood Count 18.12 $18.1 2 Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 2 Blood 13.59 $13.59 PSA Prostate S ecific A Blood 36.59 $36.59 Qua ntiferon Tb (Blood) 2. 2. CMP Com p Metabolic Panel M21.26 $20.01 Sedber Jeffrey T. Quantiferon Tb Blood 52.28 CMP (Comp Metabolic Panel $20.01 CBC (Comp Blood Count 18.12 Lipid Panel Blood 21.26 Veni uncture $3.14 HIV 1 2 Blood 13.59 $13.59 Williams. Ashley L. Quantiferon Tb Blood 52.28 $52.28 CMP Com Metabolic Panel 20.01 $20.01 CBC Com Blood Count 18.12 $18.12 Li id Panel Blood 21.26 21.26 Venipunct r 3.14 .14 HIV 1 2 Blood $13.59 $13.59 Total Charges $536.60 Total Payments Balance Due $0.00 $536.60 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date. a 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)) 02/16/12 17197 officer physicals $536.60 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $536.60 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 17197 43- 407.01 $536.60 I hereby certify that the attached invoice(s), or I I 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, February 24, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund