220313 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
` ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
CHECK AMOUNT: $254.73
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 220313
CHECK DATE: 5/21/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 20150 84 . 91 MEDICAL FEES
1081 4340700 20200 84 . 91 MEDICAL FEES
1091 4340700 20200 84 . 91 MEDICAL FEES
INVOICE
o Public Safety Medical Services
w 324 E. New York Street
E Suite 300
= Indianapolis, IN 46204
Carmel Clay Parks & Recreation/CARMELPARK Terms
Attn: Jeff Kramer Invoice Date 04/17/2013
m 1411 E. 116th Street
Carmel, IN 46032 Invoice# 00-20150
Date Employee Description Amount Balance Due
04/08/13 Thrash Debra Hepatitis B Vacc#2 $74.29 $74.2 9
Injection Fee $10.62 $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 Gays
Thank You
!xhase
.• �.^ription
y PorF APR 19 2013
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INVOICE
to Public Safety Medical Services
= 324 E. New York Street
E Suite 300
Ix Indianapolis, IN 46204
C Carmel Clay Parks & Recreation/CARMELPARK
►— Terms
Attn: Jeff Kramer
1411 E. 116th Street Invoice Date 04/24/2013
m Invoice# 00-20200
Carmel, IN 46032
Date Employee Description Amount Balance Due
S 04/15/13 Koch Carol C. Hepatitis B Vacc#2 $74.29 $74.2 9
In ection Fee $10.62 $10.6 2
Walter,Christine Hepatitis B Vacc#3 $74.29 $74.2 9
In ection Fee $10.62 $10.6 2
it Total Charges->1 $169.82
Total Payments&Balance Due-> $0.00 $169.82
Please write invoice number on payment check.
BALANCE DUE IN 15 DAYS
Our Federal Employer Identification Number is 35-2079797 THANK YOU
Purchase
Biescription / (lax-
P.O. J�'+
# —�— P or F APR 2 6 2013
Line i?escr I —--
Purchaser Date
.",oprova Date/13
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
4/17/13 20150 Medical fees $ 84.91
4/24/13 20200 Medical fees $ 84.91
4/24/13 1 20200 Medical fees $ 84.01
Total $ 254.73
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$
$ 254.73
ON ACCOUNT OF APPROPRIATION FOR
108 ESE/ 109 MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-99 20150 4340700 $ 84.91 _ 1 hereby certify that the attached invoice(s), or
1091 20200 4340700 $ 84.91 bill(s) Is (are)true and correct and that the
1081-99 20200 4340700 $ 84.91 materials or services Itemized thereon for
which charge is made were ordered and
received except
16-May 2013
Signature
$ 254.73 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund