207583 03/26/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
0 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $831.59
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 207583
,ow
CHECK DATE: 3/2612012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 17385 65.00 MEDICAL FEES
1110 4340701 17386 128.40 MEDICAL EXAM FEES
1081 4340700 17446 65.00 MEDICAL FEES
1110 4340701 17447 573.19 MEDICAL EXAM FEES
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
O Carmel Police Department 1 CARMEPD
Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 0310912012
m Invoice 00 -17386
Date Employee Description Amount Balance Due
03/02/12 Milier Michael G. Quantiferon Tb (Blood) $52.28 $52.28
CMP (Comp Metabolic Panel $20.01 $20.01
CBC (Comp Blood Count 18.12 $18.12
Lipid Panel Blood 21.26 $21.26
Veni uncture $3.14 3.14
HIV 1 2 Blood 1159 13.59
Total Charges $128.40
Total Payments Balance Due $0.00 $128.40
Please write invoice number on payment check.
Balance due 15 days from
Our Federal Employer Identification Number is 35- 2079797 1Dvoice date
INVOICE
Public Safety Medical Services
324 E. New York Street
E Suite 300
d
M Indianapolis, IN 46204
G Carmel Pofice Department 1 CARMEPD
t 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 03/15/2012
Invoice 00 -17447
Date Employee Description Amount. Balance Due
03/05/12 Collins Willie H. 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 $3.141
HIV 1 2 Blood 13.59 113.59
PSA Prostate 5 ecfic A Blood 36.59 $36.59
Robbins Todd E. Quantiferon Tb Blood 52.28 $52.28
CMP (Comp Metabolic Panel 20.01 $20.01
CBC Com Blood Count 18.12 $18.1 2
Lipid I I 21
Veni uncture $3.14 $3.14
Strong, David C. CMP (Comp Metabolic Panel 20.01 $20.01
CBC (Comp Blood Count 18.12 $18.12
Lipid Panel Blood 21.26 21.26
Veni uncture $3.14 $3,14
HIV 1 2 Blood 13.59 $13.59
PSA Prostate Specific A Blood 36.59 $36.59
Quantiferon Tb (Bloodl $52.28 $52.28
Meg man Chad R. Quantiferon Tb Blood 52.28 52.28
CMP (Comp Metabolic Panel $20.01 20.01
CBC Com Blood Count 18.12 $18.1 2
.L ijpj PZnel (Blood) $21.26
Veni uncture $3.14 $3.14
HIV 1 2 Blood $13.59 $13.59
Total Charges $573.19
Total Payments Balance Due $0.00 $573.19
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 _Balance.due 15 days-from----
Invoice date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$701.59
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO_ ACCT /TITLE AMOUNT Board Members
1110 17386 43- 407.01 $128.40 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1110 17447 43- 407.01 $573.19
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, March 22, 2012
Chief of Police
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))
03/09/12 17386 officer physicals $128.40
03/15/12 17447 officer physicals $573.19
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
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
it Indianapolis, IN 46204
o Carmel Clay Parks Recreation CARMELPARK
Terms
1411 E 116th Street
Carmel, IN 46032 Invoice Date 03I0912012
Invoice 00 -17385
Date Employee Description Amount Balance Due
03/02/12 Strong, Gail C. He atilis B Vaccination #1 $65.00 $65.00
Iniection Fee $0.00 0.00
Totaf Charges $65.00
Total Payments Balance Due $0.00 $65.00
Please write invoice number on payment check.
Balance ,anc 45 days fi om
Our Federal Employer Identification Number is 35- 2079797 Invoice date
P u rch ase
G �r
P.O. `�J P or F
G.L.
OVOO
Budget P.e� MAR 12 7�1�
Line Descr
Purchaser 3 t 3 I z
Approval Date
INVOICE
0 Public Safety Medical Services
324 E. New York Street
.E Suite 300
W Indianapolis, IN 46204
Carmel Clay Parks Recreation l CARMELPARK
1411E 116th Street Terms
Carmel, IN 46032 Invoice Date 0311512012
m Invoice 00 -17446
Date Employee Description Amount Balance Due
03/07/12 Simpson, Brea J. He atitis B Vaccination #1 $65.00 $65.O 0
Injection Fee 0.00 $0.00
Total Charges $65.00
Total Payments Balance Due $0 -00 $65.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from
Invoice date
pesrription r` pp �q,� �Q
P.O.# PorF 1! LEE V
t~. L. u 1 `f 3 7 MA 16 2012
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�isreh�ser Il Y j i L BY
�hi,'t ;UU,ai Date
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
00350364 Public Safety Medical Services Terms
324 E. New York Street, Ste 300
Indianapolis, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
3/9112 17385 Medical fees 65.00
3115112 17446 IMedical fees 65.00
Total 130.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk Treasurer
Voucher No. Warrant No.
00350364 Public Safety Medical Services Allowed 20
324 E. New York Street, Ste 300
Indianapolis, IN 46204
In Sum of$
130.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PC# or Board Members
Dept INVOICE NO. ACCT #[TITLE AMOUNT
1081 -99 17385 4340700 65.00 1 hereby certify that the attached invoice(s), or
1081 -99 17446 4340700 65.00 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
22 -Mar 2012
Signature
130.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund