HomeMy WebLinkAbout228117 1/14/2014 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $84.91
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
>oii.EvINDIANAPOLIS IN 46204 CHECK NUMBER: 228117
CHECK DATE: 1/14/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 22051 84 . 91 MEDICAL FEES
INVOICE
�o Public Safety Medical Services
324 E. New York Street
E Suite 300
w Indianapolis, IN 46204
C Carmel Clay Parks & Recreation!CARMELPARK
�- Attn: Jeff Kramer Terms
1411 E. 116th Street Invoice Date 12!30/2013
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Carmel, IN 46032 Invoice# 00-22051
Date Employee Description Amount Balance Due
12/18/13 Thrash Debra J. Hepatitis B Vacc#3 $74.29 $74.29
In ection 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
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I DEC 3 1 2013
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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
12/30/13 22051 Medical fees $ 84.91
Total $ 84.91
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$
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$ 84.91
ON ACCOUNT OF APPROPRIATION FOR
108 ESE r
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1081-99 22051 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
1
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9-Jan 2014
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Signature
$ 84.91 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund