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238417 10/21/14
�,qMf CITY OF CARMEL, INDIANA VENDOR: 367222 v! r ® "r. ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $****49,399.06* CARMEL, INDIANA 46032 2046 RELIABLE PKWY . CHECK NUMBER: 238417 9'• CHICAGO IL 60686-0020 CHECK DATE: 10/21/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 736003 4,374.16 OTHER EXPENSES 1201 4358800 736082 854.00 TESTING FEES 301 5023990 736165 28,090.00 OTHER EXPENSES 1110 4341999 736242 600.00 OTHER PROFESSIONAL FE 1120 4340701 736242 1,350.00 MEDICAL EXAM FEES 301 5023990 736242 7,785.10 OTHER EXPENSES 301 5023990 736291 1,436.00 OTHER EXPENSES 301 5023990 736652 4,909.80 OTHER EXPENSES Indiana University Health Workplace Services, LLC —3' 1 950 North Meridian Street Suite 200 Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice October 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite Fees/Sept.2014 1 Civic Square Carmel,IN 46032- Invoice# 736003 Proc Code Date Description ion -QIY Charge Receipt Adiust Balance CARMBUIL 09/01/2014 City of Carmel Clinic Build Out 1.00 2574.16 2574.16 CARMLEAS 09/01/2014 City of Carmel Sports Performance 1.00 1800.00 1800.00 Lease Balance Due: 4374.16 Invoice# 736003 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted 'T® OCT 2 0 2014 Clerk. Treasurer-J r Cut and return with payment Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice October 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite/August 2014 1 Civic Square Cannel,IN 46032- Invoice# 736291 Proc Code Date Description Qty Charae Receipt Adiust Mance 08/01/2014 Construction Build Out 1.00 1436.00 1436.00 Onsite Clinic Construction in August 2014 L ( j^ �is Balance Due: 1436.00 Invoice# 736291 Balance Due: 1436.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK ubmitted To OCT 2 0 2014 Clerk Treasurer Cut and return with gazent Indiana University Health Workplace Services, LLC 950 North Meridian Street �l Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice October 01, 2014 Bill to: Barbara Lamb For: City of Carmel- Onsite City of Carmel-Onsite Supply Billing/Sept. 2014 1 Civic Square 'I Carmel,IN 46032- Invoice# 736652 Proc Code Date Description Qty Charge ReceipAdjust Balance 99070 09/01/2014 Onsite Operating Supplies 1.00 4909.80 4909.80 September 2014 Supplies Balance Due: 4909.80 Invoice# 736652 Balance Due: 4909.80 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted T 0 C T IN 2014 Clerk Treasurer Cut and return with payment J, Indiana University Health Workplace Services, LLC _ 950 North Meridian Street Suite 200 (City of Carmel) S ubmitted Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice October 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/Sept. 2014 1 Civic Square Carmel,IN 46032- Invoice# 736165 Proc Code Die Description QU Charge Receipt Adiust Balance NURSEMA 09/02/2014 M.A.Staff Time 6.60 168.00 168.00 Kimberly Pride NURSEMD 09/02/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 09/02/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 09/03/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 09/03/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 09/03/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 09/04/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride NURSEMD 09/04/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 09/04/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 09/05/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 09/05/2014 MD Staff Time 5.00 875.00 875.00 Dr.Naz NURSERN 09/05/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 09/08/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 09/08/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 09/08/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 09/09/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberlv Pride NURSEMD 09/09/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 09/09/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 09/10/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride Invoice# 736165 (continued)page 2 NURSEMD 09/10/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 09/10/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 09/11/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride NURSEMD 09/11/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 09/11/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 09/12/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 09/12/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 09/12/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 09/15/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 09/15/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 09/15/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 09/16/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberlv Pride NURSEMD 09/16/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 09/16/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin NURSEMA 09/17/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 09/17/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 09/17/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 09/18/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride NURSEMD 09/18/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 09/18/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 09/19/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 09/19/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 09/19/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 09/22/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberlv Pride NURSEMD 09/22/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 09/22/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 09/23/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 09/23/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 09/23/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin Invoice# 736165 (continued)page 3 NURSEMA 09/24/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 09/24/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 09/24/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 09/25/2014 M.A.Staff Time 4.00 112.00 112.00 Kimberly Pride NURSEMD 09/25/2014 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 09/25/2014 R.N.Staff Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 09/26/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 09/26/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 09/26/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 09/29/2014 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 09/29/2014 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 09/29/2014 R.N.Staff Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 09/30/2014 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride NURSEMD 09/30/2014 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 09/30/2014 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin Balance Due: 28090.00 Invoice# 736165 Balance Due: 28090.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Cut and return with payment -------------------------------- 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 IU Health Workplace Services, LLC Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 101011 4 1716003 Onsite Fees/Sept 2014 4,374.16 10/01/ 4 171R901 Mise Onsite/Aug 2014 1,436.00 10101114 73616r, f01-181itee StC-3-11 IT 4,909.80 it nef Sept 20 14 28,090.00 Total 1 38,809.96 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor- dance with IC 5-11-10-1.6. , 20 Clerk-Treasurer VOUCHER NO. 10120114WARRANT NO. IU Health Workplace Services, LLC ALLOWED 20 IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $ 381809.96 ON ACCOUNT OF APPROPRIATION FOR 301 Medical Fund Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon 736003 301 $ ,374.16 for which charge is made were ordered and 736291 301 $ ,436.00 received except 736652 301 909 go 736165 301 nan nn 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund S Indiana University Health Workplace Services, LLC 1 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Submitted T® Phone: 317-963-1534 FEIN: 20-0994452 OCT 0 6 2014 Clerk Treasurer Invoice October 01, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel- Onsite Onsite/Sept. 2014 1 Civic Square Carmel,IN 46032- Invoice# 736082 Proc Code Date Descritp ion 15.00 . . .......... .. .... Invoice# 736082 (continued)page 2 09/24/2014 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit 15.00 kit 22.00 Invoice# 736082 (continued)page 3 09/19/2014 Quick Read UDS/6panel includes 15.00 kit 22.00 Invoice# 736082 (continued)page 4 09/05/2014 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit 854.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Cut and return withP aY ment ---------- -- zx 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)) 10/01/14 736082 $854.00 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. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $854.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 I 736082 I 43-588.00 I $854.00 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 Monday, October 20, 2014 Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice October 01, 2014 Bill to: Barbara Lamb For: City of Carmel- Onsite City of Carmel-Onsite Misc.Onsite/Sept 2014 1 Civic Square Carmel,IN 46032- Invoice# 736242 Proc Code Date Si-.rutted To Balance Due: 9735.10 OCT B O 2014 Invoice# 736242 Balance Due: 9735.10 MAKE PAYMENT T THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE Clef" _t f .'asun aTE PLEASE INCLUDE INVOICE#ON CHECK Invoice# 736242 (continued)page 2 Cut and return with payment _ O' --a 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)) 10/01/14 736242 Fire $1,350.00 10/01/14 I 736242 I Police I $600.00 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. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 00 qq 35. to ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members I -734 u{Z (,�» .-- I hereby certify that the attached invoice(s), or bills) is (are)true and correct and that the L' X o 736242 '� / $1,350.00 + 1 fr' G materials or services itemized thereon for I ( © I 736242 I�I/�/" / I $600.00 which charge is made were ordered and T13C1-,fz- �vY�S�o received except Monday, October 20, 2014 o r Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund