251605 11/18/15 oi�
CITY OF CARMEL, INDIANA VENDOR: 367222
ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $....48,532.69'
CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 251605
CHICAGO IL 60686-0020 CHECK DATE: 11/18/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 745057 679.00 TESTING FEES
301 5023990 745191 4,374.16 OTHER EXPENSES
301 5023990 745192 30,529.50 OTHER EXPENSES
1110 4340701 745499 150.00 MEDICAL EXAM FEES
301 5023990 745499 10,879.02 OTHER EXPENSES
1205 4347500 745511 712.80 GENERAL INSURANCE
301 5023990 745545 1,208.21 OTHER EXPENSES
L)�s
Indiana University Health Workplace Services, LLC
950 North Meridian Street )2J�
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
October 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite EAP Services/Oct. 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 745511
Service Date Description Quanti Charge Receipt Ediust Balance
10/01/2015 EAP Services 594.00 712.80 712.80
CITYCARO Invoice# 745511 Balance Due: 712.80
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
NOV 16 2015
Clerk Treasurer
Cut and return with payment
--
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
10/31/15 745511 EAP Services $712.80
1205 101
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
IU HEALTH WORKPLACE SERVICES LLC
2046 RELIABLE PKWY
IN SUM OF $
CHICAGO, IL 60686-0020
$712.80
ON ACCOUNT OF APPROPRIATION FOR
PO#/Dept. INVOICE NO. I ACCT#/Fund AMOUNT Board Members
745511 43-475.00 $712.80 I hereby certify that the attached invoice(s), or
1205 I 101
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
Tuesday, November 10, 2015
Steve Engelking, Director
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Indiana University Health Workplace Services, LLC —SS�
950 North Meridian Street 12--
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
October 31, 2015
Bill to: Barbara Lamb For: City of Carmel -Onsite
City of Carmel -Onsite Onsite/Drug Screens/Oct.
1 Civic Square
Carmel, 1N 46032-
Invoice# 745057
Service Date Description Quantit Charge Receipt Adjust Balance
....... ............... . ..... .... . ..... .... . ......
10/06/2015 Quick Read UDS/6panel
15.00
kit
Submitted T®
NOV 16 2015
Clerk Treasurer
Invoice# 745057(continued)page 2
Service Date Description
15.00
10/08/2015 Quick Read UDS/6panel includes
15.00
Invoice# 745057(continued)page 3
Service Date Description Quantit Charge Receipt Adjust Balance
10/09/2015 Quick Read UDS/6panel
15.00
Invoice# 745057(continued)page 4
Service Date Description Quantit Charge Receipt Adjust Balance
10/02/2015 Regulated Drug Screen
22.00
10/05/2015 Regulated Drug Screen
22.00
Invoice# 745057(continued)page 5
Service Date Description Quantit Charae Receipt Adjust Balance
10/05/2015 Regulated Drug Screen
15.00
CITYCARO Invoice# 745057 Balance Due: 679.00
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Cut and mtum with payment ��
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
i
Purchase Order No.
Terms
Date Due
Invoice Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
10/31/15 745057 $679.00
1201 101
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
IU HEALTH WORKPLACE SERVICES LLC
2046 RELIABLE PKWY
IN SUM OF $
CHICAGO, IL 60686-0020
$679.00
ON ACCOUNT OF APPROPRIATION FOR
PO#/Dept. INVOICE NO. I ACCT#/Fund AMOUNT Board Members
745057 j 43-588.00 j $679.00 I hereby certify that the attached invoice(s), or
1201 101 -
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, November 16, 2015
Barbara Lamb, HR Director
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Indiana University Health Workplace Services, LLC
950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
October 31, 2015
Bill to: Barbara Lamb For: City of Cannel-Onsite
City of Cannel-Onsite Misc.Onsite/Oct.2015
I Civic Square
Cannel,IN 46032-
Invoice# 745499
Service Date
1.00 112.55 112.55
CITYCARO Invoice# 745499 Balance Due: 11029.02
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
A Cut and return with payment
Indiana University Health Workplace Services, LLC
950 North Meridian Street c�1
Suite 950 (City of Carmel)
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
October 31, 2015
Bill to: Barbara Lamb For: City of Carmel-Onsite
City of Carmel-Onsite Supply Billing/Oct. 2015
1 Civic Square
Carmel, IN 46032-
Invoice# 745545
Service Date Description Quanti Charge Receipt Ad— Balance
10/01/2015
CITYCARO Invoice# 745545 Balance Due: 1208.21
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
NOV 16 2015
Clerk Treasurer
Cut and retum with payment
d..-COF-1------------------------------------------------------------------------------------------------------------
Indiana University Health Workplace Services, LLC
950 North Meridian Street ��1
Suite 950
Indianapolis, IN 46204
317-963-1535
Tax ID# 20-0994452
Invoice
October 31, 2015
Bill to: Barbara Lamb For: City of Carmel -Onsite
City of Carmel-Onsite Onsite Fee's/Oct. 2015
1 Civic Square
Carmel,IN 46032-
Invoice# 745191
Service Date Description Quanti Charge Receipt Adjust Balance
10/01/2015 City of Carmel Sports Performance 1.00 1.800.00 1800.00
Lease
10/01/2015 City of Cannel Clinic Build Out 1.00 2.574.16 2574.16
CITYCARO Invoice# 745191 Balance Due: 4374.16
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Submitted To
NOV 16 2015
Clerk Treasurer
-Cut and return with payment
Indiana University Health Workplace Services, LLC
950 North Meridian Street
Suite 950 (City of Carmel)
Indianapolis, IN 46204 �c�l
317-963-1535
Tax ID# 20-0994452
Invoice
October 31, 2015
Bill to: Barbara Lamb For: City of Carmel -Onsite
City of Carmel-Onsite Staff Time/Oct. 2015
1 Civic Square
Cannel, 1N 46032-
Invoice# 745192
Service Date Description Quanti Charge Receipt Adjust Balance
10/01/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
10/01/2015 M.A.Staff Time 7.25 203.00 203.00
Kinrberly Pride
10/01/2015 R.N.Staff Time 6.50 403.00 403.00
Alareesa Marlin
10/02/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
10/02/2015 M.A.Staff Time 8.50 238.00 238.00
Kinrberly Pride
10/02/2015 R.N.Staff Time 7.50 465.00 465.00
Alareesa Martin
10/05/2015 MD Staff Time 5.00 875.00 875.00
Dr. Fagan
10/05/2015 M.A.Staff Time 7.50 210.00 210.00
Kinrberly Pride
10/05/2015 R.N.Staff Time 6.00 372.00 372.00
Alareesa Martin
10/06/2015 MD Staff Time 6.00 1.050.00 1050.00
Dr. Fagan
10/06/2015 M.A.Staff Time 7.50 210.00 210.00
Kimberly Pride
10/06/2015 R.N.Staff Time 6.50 403.00 403.00
Alareesa Martin
10/07/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
10/07/2015 M.A.Staff Time 8.00 224.00 224.00
Kimberly Pride
10/07/2015 R.N.Staff Time 6.00 372.00 372.00
Alareesa Martin
10/08/2015 MD Staff Time 4.00 700.00 700.00
Dr. Fagan
Submitted To
NOV 16 2015
Clerk Treasurer
Invoice# 745192 (continued)page 2
Service Date Descriptio Quantit Charge Receipt Adjust Balance
10/08/2015 M.A.Staff Time 5.75 161.00 161.00
Kimberly Pride
10/08/2015 R.N.Staff Time 5.50 341.00 341.00
Alareesa Martin
10/09/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
10/09/2015 M.A.Staff Time 7.00 196.00 196.00
Kimberly Pride
10/09/2015 R.N.Staff Time 5.50 341.00 341.00
Alareesa Martin
10/12/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
10/12/2015 M.A.Staff Time 6.00 168.00 168.00
Kimberlv Pride
10/12/2015 R.N.Staff Time 5.50 341.00 341.00
Alareesa Martin
10/13/2015 MD Staff Time 6.00 1.050.00 1050.00
Dr.Fagan
10/13/2015 M.A.Staff Time 6.75 189.00 189.00
Kimberlv Pride
10/13/2015 R.N.Staff Time 6.75 418.50 418.50
Alareesa Alartin
10/14/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
10/14/2015 M.A.Staff Time 6.00 168.00 168.00
Kimberlv Pride
10/14/2015 R.N.Staff Time 8.00 496.00 496.00
Alareesa Martin
10/15/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
10/15/2015 M.A.Staff Time 4.50 126.00 126.00
Kimberlv Pride
10/15/2015 R.N.Staff Time 4.50 279.00 279.00
Alareesa Marlin
10/16/2015 MD Staff Time 5.00 875.00 875.00
Dr. Fagan
10/16/2015 M.A.Staff Time 6.00 168.00 168.00
Kimberlv Pride
10/16/2015 R.N.Staff Time 5.50 341.00 341.00
Alareesa Martin
10/19/2015 M.A.Staff Time 5.50 154.00 154.00
KimberlY Pride
10/19/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
10/19/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
10/20/2015 M.A.Staff Time 6.00 168.00 168.00
Kimberlv Pride
Invoice# 745192(continued)page 3
Service Date Description Quanti Charge Receipt Adjust Balance
10/20/2015 R.N.Staff Time 6.50 403.00 403.00
Alareesa Martin
10/20/2015 MD Staff Time 6.00 1.050.00 1050.00
Dr.Fagan
10/21/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
10/21/2015 R.N. Staff Time 5.50 341.00 341.00
Alareesa Martin
10/21/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
10/22/2015 M.A.Staff Time 4.50 126.00 126.00
Kimberly Pride
10/22/2015 R.N.Staff Time 4.50 279.00 279.00
Alareesa Martin
10/22/2015 MD Staff Time. 4.00 700.00 700.00
Dr. Fagan
10/23/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
10/23/2015 R.N.Staff Time 5.50 341.00 341.00
Alareesa Martin
10/23/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
10/26/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberb Pride
10/26/2015 R.N.Staff Time 5.50 341.00 341.00
Alareesa Martin
10/26/2015 N.P.Staff Time 5.00 560.00 560.00
Kell v Jones
10/27/2015 M.A.Staff Time 6.50 182.00 182.00
KinrberlY Pride
10/27/2015 R.N.Staff Time 6.50 403.00 403.00
Mareesa Martin
10/27/2015 MD Staff Time 6.00 1.050.00 1050.00
Dr.Fagan
10/28/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
10/28/2015 R.N.Staff Time 5.50 341.00 341.00
Mareesa Martin
10/28/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
10/29/2015 M.A.Staff Time 4.50 126.00 126.00
Kimberly Pride
10/29/2015 R.N.Staff Time 4.50 279.00 279.00
Mareesa Martin
10/29/2015 MD Staff Time 4.00 700.00 700.00
Dr.Fagan
10/30/2015 M.A.Staff Time 5.50 154.00 154.00
Kimberly Pride
Invoice# 745192(continued)page 4
Service Date Description Quanti Charge Receioi Adjust Balance
10/30/2015 R.N.Staff Time 5.50 341.00 341.00
Alareesa Martin
10/30/2015 MD Staff Time 5.00 875.00 875.00
Dr.Fagan
CITYCARO Invoice# 745192 Balance Due: 30529.50
MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE
INVOICE#ON CHECK
Cut and return with payment r
----------------------------------------------------------------------------------------------------
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
10/31/15 745499 Misc Onsite Oct 2015 PD 470-01 $150.00
p/D 4701e /
10/31/15 745499 Misc Onsite Oct 2015 HR $10,879.02
301 301
10/31/15 745545 Suppy Billing Oct 2015 $1,208.21
301 301
10/31/15 745191 Onsite Fees Oct 2015 $4,374.16
301 301
10/31/15 745192 Staff Time Oct 2015 $30,529.50
301 301
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
IU HEALTH WORKPLACE SERVICES LLC
2046 RELIABLE PKWY
IN SUM OF $
CHICAGO, IL 60686-0020
$47,140.89
ON ACCOUNT OF APPROPRIATION FOR
PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT
Board Members
11 745499
� /'7d �,� $150.00 I hereby certify that the attached invoice(s), or
745499 110-100.00 $10,879.02 bill(s) is (are)true and correct and that the
301 301
745545 110-100.00 $1,208.21 materials or services itemized thereon for
301 301 which charge is made were ordered and
745191 110-100.00 $4,374.16
301 301 received except
745192 110-100.00 $30,529.50
301 301
Monday, November 16, 2015
Cost distribution ledger classification if
claim paid motor vehicle highway fund