HomeMy WebLinkAbout213626 10/09/2012 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: $258.40
INDIANAPOLIS IN 46204 CHECK NUMBER: 213626
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 18930 130 . 00 MEDICAL FEES
1110 4340701 18931 128 .40 MEDICAL EXAM FEES
INVOICE
to Public Safety Medical Services
.. 324 E.New York Street
E Suite 300
W Indianapolis, IN 46204
O Carmel Police Department/CARMEPD
F' 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 09/2612012
m Invoice# 00-18931
Date Employee Description Amount Balance Due
09/17/12 White.Kan E. 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 13.59 13.59
Total Charges-> 1 $128.40
Total Payments&Balance Due-> $0.00 1 $128.40
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
$128.40
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 ( 18931 I 43-407.01 I $128.40 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
Friday, October 05, 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))
09/26/12 18931 officer physical $128.40
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
H Public Safety Medical Services
324 E. New York Street -
E Suite 300
m Indianapolis, IN 46204
o Carmel Clay Parks & Recreation! CARMELPARK
�- Terms
1411E 116th Street
Carmel, IN 46032 Invoice Date 09/26/2012
m Invoice# 00-18930
Date Employee Description Amount Balance Due
09/18/12 Strong, Gail C. Hepatitis B Vaccination#3 $65.00 $65.00 6-
Injection Fee $0.00 $0.00
09/19/12 Simpson, Brea J. Hepatitis B Vaccination#3 $65.00 $65.00 C
Injection Fee $0.00 $0.00
Total Charges-> $130.00
Total Payments&Balance Due-> $0.00 $130.00
Please write-invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35-2079797 date
T :D
Purchase
Description T/`Q - S E P 2 8 2012
P.O.# PorF
y3 �( U ,700
G.L.#
'.:
Budnat e S
Line Uascr
Purchaser �� Z
Approval __Data
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
9/26/12 18930 Medical fees $ 130.00
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
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-99 18930 4340700 $ 130.00 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
4-Oct 2012
Signature
$ 130.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund