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Home My WebLink About210515 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