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Home My WebLink About252335 1 2/08/1 5 (9, CITY OF CARMEL, INDIANA VENDOR: 367222 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $****50,037.45* CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 252335 CHICAGO IL 60686-0020 CHECK DATE: 12/08/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 745756 104.00 TESTING FEES 301 5023990 745816 4,374.16 OTHER EXPENSES 301 5023990 745817 27,083.00 OTHER EXPENSES 301 5023990 746179 529.04 OTHER EXPENSES 301 5023990 746204 17,234.45 OTHER EXPENSES 1205 4347500 746225 712.80 GENERAL INSURANCE Indiana University Health Workplace Services, LLC _50� 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice November 30, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/Nov.2015 1 Civic Square Carmel,IN 46032- Invoice# 745817 Service Date Description Quanti Charge Receipt Adjust Balance 11/02/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 11/02/2015 R.N.Staff Time 6.50 403.00 403.00 Mareesa Martin 11/02/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 11/03/2015 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 11/03/2015 R.N.Staff Time 8.00 496.00 496.00 Mareesa Martin 11/03/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 11/04/2015 M.A.Staff Time 7.00 196.00 196.00 Kimberly Pride 11/04/2015 R.N.Staff Time 7.50 465.00 465.00 Mareesa Martin 11/04/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 11/05/2015 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 11/05/2015 R.N.Staff Time 7.00 434.00 434.00 - Mareesa Martin 11/05/2015 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 11/06/2015 M.A.Staff Time 7.00 196.00 196.00 Kimberly Pride 11/06/2015 R.N.Staff Time 7.50 465.00 465.00 Mareesa Martin 11/06/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 11/09/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan Fm-ittc'd To DEC 0 7 2015 Clerk Treasure) Invoice# 745817(continued)page 2 Service Date Descrii)tio Quanti Charge Receiol Adjust Balance 11/09/2015 M.A.Staff Time 7.50 210.00 210.00 Kimberly Pride 11/09/2015 R.N.Staff Time 7.00 434.00 434.00 Mareesa Martin 11/10/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 11/10/2015 M.A.Staff Time 7.00 196.00 196.00 Kimberly Pride 11/10/2015 R.N.Staff Time 8.00 496.00 496.00 Mareesa Martin 11/12/2015 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 11/12/2015 M.A.Staff Time 7.50 210.00 210.00 Kimberly Pride 11/12/2015 R.N.Staff Time 7.50 465.00 465.00 Mareesa Martin 11/13/2015 N.P.Staff Time 5.00 560.00 560.00 Jessica Lee Luh 11/13/2015 M.A.Staff Time 7.50 210.00 210.00 Kimberly Pride 11/13/2015 R.N.Staff Time 8.00 496.00 496.00 Mareesa Martin 11/16/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 11/16/2015 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin 11/16/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 11/17/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 11/17/2015 R.N.Staff Time 7.00 434.00 434.00 Mareesa Martin 11/17/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 11/18/2015 M.A.Staff Time 7.00 196.00 196.00 Kimberly Pride 11/18/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 11/18/2015 MD Staff Time 5.00 875.00_ 875.00 Dr.Fagan 11/19/2015 M.A.Staff Time 5.00 140.00 140.00 Kimberly Pride 11/19/2015 R.N.Staff Time 7.00 434.00 434.00 Mareesa Martin 11/19/2015 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 11/20/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride Invoice# 745817(continued)page 3 Service Date Description Quantily Charge Receipt Adiust Balance 11/20/2015 R.N.Staff Time 6.50 403.00 403.00 Mareesa Martin 11/20/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 11/23/2015 M.A.Staff Time 8.50 238.00 238.00 Kimberly Pride 11/23/2015 R.N.Staff Time 8.00 496.00 496.00 Mareesa Martin 11/23/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 11/24/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 11/24/2015 R.N.Staff Time 8.50 527.00 527.00 Mareesa Martin 11/24/2015 MD Staff Time 6.00 1,050.00 _1050.00 Dr.Fagan 11/25/2015 M.A.Staff Time 8.50 238.00 238.00 Kimberly Pride 11/25/2015 R.N.Staff Time 8.00 496.00 496.00 Mareesa Martin 11/25/2015 MD Staff Time 5.00 875.00 875.00 Dr.Faget: 11/30/2015 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 11/30/2015 R.N.Staff Time 6.00 372.00 372.00 Mareesa Marlin 11/30/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan CITYCARO Invoice# 745817 Balance Due: 27083.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK (Sit and-f-with---t _tel Indiana University Health Workplace Services,LLC 950 North Meridian Street Suite 950 Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice November 30, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite Fee's/Nov.2015 1 Civic Square Carmel,IN 46032- Invoice# 745816 Service Date Description Quanti Charge Recei Adjust Balance 11/01/2015 City of Carmel Sports Performance 1.00 1,800.00 1800.00 Lease 11/01/2015 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16 CITYCARO Invoice# 745816 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To DEC 0 7 2015 Clerk T reas rer Gut and return with_payment 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 November 30, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Supply Billing/Nov.2015 1 Civic Square Carmel,IN 46032- Invoice# 746179 Service Date Description Quantily Charge Receipt Adiust Balance 11/01/2015 Onsite Operating Supplies 1.00 529.04 529.04 November 2015 Supplies CITYCARO Invoice# 746179 Balance Due: 529.04 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To DEC .0 7 2015 Clerk 'rea�Lyjrer Gut and return with payment 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 November 30, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/Nov.2015 1 Civic Square Carmel,IN 46032- Invoice# 746204 Service Date Description Quantily Care Recei t Adjust Balance 10/31/2015 Onsite Lab Charges 1.00 3,747.38 3747.38 October 2015 Labs 11/01/2015 Young at Heart Mail-Ins 1.00 8,610.74 8610.74 11/01/2015 Young at Heart Clinic Meds 1.00 4,876.33 4876.33 CITYCARO Invoice# 746204 Balance Due: 17234.45 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Sub-milted To DEC 0 -1201-5 ---- Clerk Treasurer Cut and return with payment VOUCHER NO. WARRANT NO. ALLOWED 20 IU HEALTH WORKPLACE SERVICES LLC 2046 RELIABLE PKWY IN SUM OF$ i CHICAGO, IL 60686-0020 $49,220.65 ON ACCOUNT OF APPROPRIATION FOR PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members 745817 110-100.00 $27,083.00 1 hereby certify that the attached invoice(s), or 301 301 745816 110-100.00 $4,374.16 bill(s) is (are)true and correct and that the 301 301 746179 110-100.00 $529.04 materials or services itemized thereon for 301 301 which charge is made were ordered and 746204 110-100.00 $17,234.45 301 301 received except Monday, December 07, 2015 Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 11/30/15 745817 Staff Time $27,083.00 301 301 11/30/15 745816 Onsite Fees $4,374.16 301 301 11/30/15 746179 Supply Billing $529.04 301 301 11/30/15 746204 Misc Onsite $17,234.45 301 301 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Clerk-Treasurer Indiana University Health Workplace Services,LLC z 5 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice November 30, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite EAP Services/Nov.2015 1 Civic Square Carmel,IN 46032- Invoice# 746225 Service Date Description Quanti Charge Receipt Adjust Balance 11/01/2015 EAP Services 594.00 712.80 712.80 CITYCARO Invoice# 746225 Balance Due: 712.80 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK ulfe To DEC 0:7:2015 Clerk T reSurr + --- ..and return with payment Please remit 712.80 and Make Check Payable to: 11 VISA INVOICE# 746225 IU Health Workplace Services,LLC El li MASTERCARD 2046 Reliable Pkwy Chicago,IL 60686-0020 ACCOUNTNO Csv EXP CODE DATE Phone: 317-963-1535 SIGNATURE AMOUNT PAID VOUCHER NO.' WARRANT NO. ALLOWED 20 IU HEALTH WORKPLACE SERVICES LLC 2046 RELIABLE PKWY IN SUM OF$ CHICAGO, IL 60686-0020 $712.80 ON ACCOUNT OF APPROPRIATION FOR PO#/Dept. INVOICE NO. I ACCT#/Fund AMOUNT Board Members I 746225 I 43-475.00 I $712.80 1 hereby certify that the attached invoice(s), or 1205_ 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, December 07, 2015 Ae Cost distribution ledger classification if claim paid motor vehicle highway fund I 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)) 11/30/15 746225 $712.80 1205 101 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 , 20 Clerk-Treasurer 15MIndiana University Health Workplace Services, LLC �2 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice November 30, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite/Drug Screens/Nov. 1 Civic Square Carmel,IN 46032- Invoice# 745756 Service Date Description Quanti Charge Receipt Adjust Balance --- -------- - - - -- ------------ -- —--- ------------------------ ---- ------- 11/24/2015 Quick Read UDS/6panel 15.00 To- DEC 0 7 2015 Clary "`)"ensurer Invoice# 745756(continued)page 2 Service Date Description Quanti Charge Receipt A&US Balance CITYCARO Invoice# 745756 Balance Due: 104.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK -tit and return with payment -- Please remit 104.00 and Make Check Payable to: N Health Workplace Services,LLC ❑� VISA INVOICE# 745756 ❑ MASTERCARD 2046 Reliable Pkwy Chicago,IL 60686-0020 ACCOUNrNO Csv EXP CODE DATE Phone: 317-963-1535 SIGNATURE AMOUNT PAID VOUCHER NO. WARRANT NO. ALLOWED 20 IU HEALTH WORKPLACE SERVICES LLC 2046 RELIABLE PKWY IN SUM OF$ CHICAGO, IL 60686-0020 $104.00 ON ACCOUNT OF APPROPRIATION FOR PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members 745756 I 43-588.00 I $104.00 1 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, December 07, 2015 Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 11/30/15 I 745756 I Onsite/Drug Screens Nov I $104.00 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