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CITY OF CARMEL, INDIANA VENDOR: 367222
ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $`•''35,065.80"
CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 238974
CHICAGO IL 60686-0020 CHECK DATE: 11/05/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 736819 28,930.00 OTHER EXPENSES
301 5023990 736947 4,374.16 OTHER EXPENSES
301 5023990 737295 1,761.64 OTHER EXPENSES
Indiana University Health Workplace Services, LLC
-3o) 950 North Meridian Street
Suite 950
Indianapolis, IN 46204
Phone: 317-963-1535
FEIN: 20-0994452
Invoice
November 03, 2014
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Onsite Fees/Oct.2014
1 Civic Square
Carmel,IN 46032-
Invoice# 736947
Proc Code pate, Aescri tP ion SSC Charge Receipt $dust Balance
CARMBUIL 10/01/2014 City of Carmel Clinic Build Out 1.00 2574.16 2574.16
CARMLEAS 10/01/2014 City of Carmel Sports Performance 1.00 1800.00 1800.00
Lease
Balance Due: 4374.16
Invoice# 736947 Balance Due: 4374.16
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE
DATE-PLEASE INCLUDE INVOICE#ON CHECK
Indiana University Health Workplace Services, LLC
950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
Phone: 317-963-1535
FEIN: 20-0994452
Invoice
November 03, 2014
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Supply Billing/Oct.2014
1 Civic Square
Carmel,IN 46032-
Invoice# 737295
Proc Code Date Description Charge ReceipBalance
99070 10/01/2014 Onsite Operating Supplies 1.00 1761.64 1761.64
October 2014 Supplies
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Balance Due: 1761.64
Invoice# 737295 Balance Due: 1761.64
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE
DATE-PLEASE INCLUDE INVOICE#ON CHECK
�, _ Gut and retam with payment
Indiana University Health Workplace Services,LLC
950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
Phone: 317-963-1535
FEIN: 20-0994452
Invoice
November 03, 2014
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Staff Time/Oct.2014
1 Civic Square
Carmel,IN 46032-
Invoice# 736819
Proc Code Date Description Qy Charoe Receipt Adiust Balance
NURSEMA 10/01/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 10/01/2014 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 10/01/2014 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 10/02/2014 M.A.Staff Time 4.00 112.00 112.00
Kimberly Pride
NURSEMD 10/02/2014 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
NURSERN 10/02/2014 R.N.Staff Time 4.00 248.00 248.00
Mareesa Martin
NURSEMA 10/03/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 10/03/2014 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 10/03/2014 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 10/06/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 10/06/2014 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 10/06/2014 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 10/07/2014 M.A.Staff Time 6.00 168.00 168.00
Kimberly Pride
NURSEMD 10/07/2014 MD Staff Time 6.00 1050.00 1050.00
Dr.Fagan
NURSERN 10/07/2014 R.N.Staff Time 6.00 372.00 372.00
Mareesa Martin
NURSEMA 10/08/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 10/08/2014 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 10/08/2014 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 10/09/2014 M.A.Staff Time 4.00 112.00 112.00
Kimberly Pride
Invoice# 736819(continued)page 2
NURSEMD 10/09/2014 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
NURSERN 10/09/2014 R.N.Staff Time 4.00 248.00 248.00
Mareesa Martin
NURSEMA 10/10/2014' M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 10/10/2014 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 10/10/2014 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 10/13/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSENP 10/13/2014 N.P.Staff Time 5.00 475.00 475.00
Randi Antworth
NURSERN 10/13/2014 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 10/14/2014 M.A.Staff Time 6.00 168.00 168.00
Kimberly Pride
NURSENP 10/14/2014 N.P.Staff Time 6.00 570.00 570.00
Randi Antworth
NURSERN 10/14/2014 R.N.Staff Time 6.00 372.00 372.00
Mareesa Martin
NURSEMA 10/15/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSENP 10/15/2014 N.P.Staff Time 5.00 475.00 475.00
Randi Antworth
NURSERN 10/15/2014 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 10/16/2014 M.A.Staff Time 4.00 112.00 112.00
Kimberly Pride
NURSEMD 10/16/2014 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
NURSERN 10/16/2014 R.N.Staff Time 4.00 248.00 248.00
Mareesa Martin
NURSEMA 10/17/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 10/17/2014 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 10/17/2014 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 10/20/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 10/20/2014 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 10/20/2014 R.N.Staff Time 5.00 310.00 310.00
Betty Hartley
NURSEMA 10/21/2014 M.A.Staff Time 6.00 168.00 168.00
Kimberly Pride
NURSEMD 10/21/2014 MD Staff Time 6.00 1050.00 1050.00
Dr.Fagan
NURSERN 10/21/2014 R.N.Staff Time 6.00 372.00 372.00
Nicole Jackson
NURSEMA 10/22/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 10/22/2014 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 10/22/2014 R.N.Staff Time 5.00 310.00 310.00
Nicole Jackson
Invoice# 736819(continued)page 3
NURSEMA 10/23/2014 M.A.Staff Time 4.00 112.00 112.00
Kimberly Pride
NURSEMD 10/23/2014 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
NURSERN 10/23/2014 R.N.Staff Time 4.00 248.00 248.00
Mareesa Martin
NURSEMA 10/24/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 10/24/2014 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 10/24/2014 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 10/27/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 10/27/2014 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 10/27/2014 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 10/28/2014 M.A.Staff Time 6.00 168.00 168.00
Kimberly Pride
NURSEMD 10/28/2014 MD Staff Time 6.00 1050.00 1050.00
Dr.Fagan
NURSERN 10/28/2014 R.N.Staff Time 6.00 372.00 372.00
Mareesa Martin
NURSEMA 10/29/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 10/29/2014 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 10/29/2014 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
NURSEMA 10/30/2014 M.A.Staff Time 4.00 112.00 112.00
Kimberly Pride
NURSEMD 10/30/2014 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
NURSERN 10/30/2014 R.N.Staff Time 4.00 248.00 248.00
Mareesa Martin
NURSEMA 10/31/2014 M.A.Staff Time 5.00 140.00 140.00
Kimberly Pride
NURSEMD 10/31/2014 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
NURSERN 10/31/2014 R.N.Staff Time 5.00 310.00 310.00
Mareesa Martin
Balance Due: 28930.00
Invoice# 736819 Balance Due: 28930.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE
DATE-PLEASE INCLUDE INVOICE#ON CHECK
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Invoice# 736819(continued)page 4
- I,1
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))
4,374.16
11/03/14
1
11/03/1 ,761.64
28,930.00
11/03/14 736b19 0,isite Staff Time!Oet 2014
35,065. 0
Total
I 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
20Clerk-Treasurer
VOUCHER N00/05/14 WARRANT NO.
ALLOWED 20
IU Health Workplace Services, LLC
IN SUM OF $
2046 Reliable Pkwy
Chicago, IL 60686-0020
$35,065.80
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Fund
Board Members
PO#or
DEPT.# INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s),
or bill(s) is (are) true and correct and that
the materials or services itemized thereon
736947 301 4,374.16 for which charge is made were ordered and
received except
737295 $1,761.64
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20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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