HomeMy WebLinkAbout219000 04/09/2013 °,AwF CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
t` ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
CHECK AMOUNT: $834.91
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204
CHECK NUMBER: 219000
CHECK DATE: 4/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 19926 84 . 91 MEDICAL FEES
1110 4340701 20016 750 . 00 MEDICAL EXAM FEES
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
d
W Indianapolis, IN 46204
C Carmel Police Department/CARMEPD Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 03/28/2013
m Invoice# 00-20016
Date Employee Description Amount Balance Due
03/22/13 Driver Charles E. PSY-Fit For Duty Psych Eyal Initial 750.00 750.00
Total Charges-> $750.00
Total Payments&Balance Due-> $0.00 $750.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35-2079797
Balance due 15 days
from invoice date
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
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
Public Safety Medical Services Purchase Order No.
324 E New York St Suite 300
Indpls, IN 46204 Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3198111 90016 Psych evaluation Sgt. C Driver 750.00
Total
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services IN SUM OF $
324 E New York St
Suite 300
Indpls, IN 46204
$ 750.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Dept
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
1110 20016 43-407.01 750.00 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
April 1 , 2013
Signature
Gk/ief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
INVOICE �„ �.,�1� ',I
o Public Safety Medical Services MAR 1 2013
324 E. New York Street I
E Suite 300
o: Indianapolis, IN 46204
C Carmel Clay Parks & Recreation/CARMELPARK
�— Terms
Attn: Jeff Kramer
1411 E. 116th Street Invoice Date 03/13/2013
m Carmel, IN 46032 Invoice# 00-19926
.Date Employee - Description I Amount Balance Due
03/05/13 Thrash Debra Hepatitis B Vacc#1 1 $74.29 $74.29
In ection Fee 10.62 1 $10.62
Total Charges-> $84.91
Total Payments&Balance Due-> $0.00 $84.91
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35-2079797 Balance Due 15 days from invoice
date
Purchase ��� � �
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Purchaser
A"Pproval
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be property 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
3/13/13 19926 Medical fees $ 84.91
Total $ 84.91
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
Voucher No. Warrant No.
00350364 Public Safety Medical Services Allowed 20
324 E. New York Street, Ste 300
Indianapolis, IN 46204
In Sum of$
$ 84.91
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO#or INVOICE NO. ACCT#MTLE AMOUNT Board Members
Dept#
1081-99 19926 4340700 $ 84.91 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-Apr 2013
Signature
$ 84.91 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund