HomeMy WebLinkAbout209829 06/18/2012 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: $90.00
INDIANAPOLIS IN 46204
CHECK NUMBER: 209829
CHECK DATE: 6118/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4340700 17964 65.00 MEDICAL FEES
1091 4340700 18096 25.00 MEDICAL FEES
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Clay Parks Recreation CARMELPARK
I 1411 E 116th Street Terms
Carmel, IN 46032 Invoice Date 05/17/2012
m Invoice 00 -17964
Date Employee Description Amount Balance Due
05/07/12 Hammons Jennifer L. Hepatitis B Vaccination #1 $65.00 $65.00
Injection Fee $0.00 $0.00
Total Charges 1 $65.00
Total Payments Balance Due $0.00 1 $65.00
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 date
Purchase
Description
G. W 'A MAY 2 2012
Line D�'
Date Purcha
Approval Date
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
o Carmel Clay Parks Recreation CARMELPARK
f- Terms
1411 E 116th Street
Carmel, IN 46032 Invoice Date 06/01/2012
m Invoice 00 -18096
Date Employee Description I Amount Balance Due
05/21/12 Walter Christine HB SAb Quantitative Titer 25.00 $25.00
Veni uncture $0.00 $0.00
Total Charges $25.00
Total Payments Balance Due $0.00 $25.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Balance due 15 days from invoice
date
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Line Descr I/1�� 1� a 1' (I l�-L e S JUN 0 4 2012
Purchaser
Approval Date BY.
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
5/17/12 17964 Medical fees 65.00
6/1/12 18096 Medical fees 25.00
Total 90.00
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
90.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE 109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -99 17964 4340700 65.00 1 hereby certify that the attached invoice(s), or
1091 18096 4340700 25.00 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
14 -Jun 2012
Signature
90.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund