210515 07/05/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
e ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $922.53
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 210515
CHECK DATE: 7/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 17671 65.00 MEDICAL FEES
1091 4340700 17671 65.00 MEDICAL FEES
1091 4340700 18205 65.00 MEDICAL FEES
1110 4340701 18206 128.40 MEDICAL EXAM FEES
1110 4340701 18261 243.21 MEDICAL EXAM FEES
1110 4340701 18325 355.92 MEDICAL EXAM FEES
INVOICE
to— Public Safety Medical Services
324 E. New York Street
E Suite 300
ix Indianapolis, IN 46204
C Carmel Police Department CARMEPD
Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 06/20/2012
m Invoice 00 -18261
Date Employee Description Amount Balance Due
06/13/12 Long, Scott D. 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
HIV 1 2 Blood 13.59 $13.59
Martin Brian A. CBC (Comp Blood Count 18.12 $18.1 2
Lipid Panel Blood 21.26 $21.26
Veni uncture 3.14 1 3.14
uantiferon Tb Blood 52.28 $52.28
P (Comp Metabolic P 1 L2L.L1
Total Charges $243.21
Total Payments Balance Due $0.00 $243.21
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
i
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
o Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 06/14/2012
m Invoice 00 -18206
Date Employee Description Amount Balance Due
06/04/12 Thomas, Richard E. Quantiferon Tb Blood $52.28 $52.28
CMP (Comp Metabolic Panel 20.01 $20.01
CBC (Comp Blood Count 18.12 $18.1 2
Li id Panel Blood $21.26 $21.26
Veni uncture $3.14 $3.14
HIV 1 2 Blood 13.59 J13 .59
Total Charges $128.40
Total Payments Balance Due $0.00 $128.40
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Balance due 15 days from invoice
date
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
IY Indianapolis, IN 46204
o Carmel Police Department/ CARMEPD
Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 06/27/2012
m Invoice 00 -18325
Date Employee Description Amount Balance Due
06/18/12 Dietz Aaron K. 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
HIV 1 2 Blood 13.59 $13.59
PSA Prostate Specific A Blood 36.59 $36.59
Flaming, Anna G. Quantiferon Tb Blood 52.28 $52.28
CMP (Comp Metabolic Panel 20.01 $20.01
CBC Com Blood Count 18.12 $18.12
Lipid Panel 21
Veni uncture $3.14 $3.14
HIV 1 2 Blood $13.59 $13.59
Harris Sarah E. Tb Review Hx Positive Questionnaire $0.00 $0.00
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
Total Charges $355.92
Total Payments Balance Due $0.00 $355.92
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
$727.53
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1110 18206 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 18261 43- 407.01 $243.21
materials or services itemized thereon for
1110 18325 43- 407.01 $355.92 which charge is made were ordered and
received except
Friday, June 29, 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
nvoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
06/14/12 18206 officer physicals $128.40
06/20/12 18261 officer physicals $243.21
06/27/12 j 18325 j officer physicals $355.92
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
INVOICE
Fo_ Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
c Carmel Clay Parks Recreation CARMELPARK
1411 E 116th Street Terms
Carmel, IN 46032 Invoice Date 04/1112012
m Invoice 00 -17671
Date Employee Description Amount Balance Due
04/02/12 Strong Gail C. Hepatitis B Vaccination #2 $65.00 $65.0 0
In ection Fee $0.00 $0.00
n 04/03/12 Ran Kim A. Hepatitis B Vaccination #1 65.00 $65.00
Iniection Fee $0.00 $0.00
Total Charges $130:00
Total Payments &.Balance Due $0:00 1 $130.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
JUN 12 2012
BY:
Purchase
Description Q l I S
P.O. P or F
G.L.
Budget
Line Oescr
Purchas r Date 12—
Approval Date
ob
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
X Indianapolis, IN 46204
o Carmel Clay Parks Recreation CARMELPARK
1411 E 116th Street Terms
Carmel, IN 46032 Invoice Date 06/14/2012
m Invoice 00 -18205
Date Employee Description Amount Balance Due
06/07/12 Walter, Christine Hepatitis B Vaccination #1 $65.00 $65.00
In ection 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
RECEIVED
Purchase S JUN 2012
Description
P.O. P or F BY:
G.L.# U
Budget e
Line Descr
Purchaser Date l 9 IL Z
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
4/11/12 17671 Medical fees 65.00
_4/11/12. 17671 Medical fees 65.00
6/14/12 18205 Medical fees 65.00
Total 195.00
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
195.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE 109 Monon Center
PO# or INVOICE N0. ACCT #TTITLE AMOUNT Board Members
Dept
1091 17671 4340700 65.00 1 hereby certify that the attached invoice(s), or
1081 -99 17671 4340700 65.00 bill(s) is (are) true and correct and that the
1091 18205 4340700 65.00 materials or services itemized thereon for
which charge is made were ordered and
received except
28 -Jun 2012
Signature
195.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund