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Home My WebLink About302669 08/31/16 CITY OF CARMEL, INDIANA VENDOR: 00350364 4. ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $....19,530.69* CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 302669 9M[T�N ` INDIANAPOLIS IN 46204 CHECK DATE: 08/31/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 24831 00-28928 18,730.03 DEPARTMENT PHYSICALS 1110 4340701 00-28929 800.66 MEDICAL EXAM FEES VOUCHER NO. WARRANT NO. ALLOWED 20 Prescribed by State Board of Accounts City Form No.201 (Rev.1995)PUBLIC SAFETY MEDICAL SERVICES ACCOUNTS PAYABLE VOUCHER 324 E NEW YORK ST SUITE 300 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service INDIANAPOLIS, IN 46204 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $18,730.03 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT#- FUND# (or note attached invoice(s)or bill(s)) AMOUNT 24831 28928 43-407.01 $18,730.03 1 hereby certify that the attached invoice(s),or 8/22/16 28928 $18,730.03 1120 101 1120 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,August 22,2016 David Haboush Fire Chief 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Public Safety Medical - INVOICE H Public Safety Medical Invoice Date: 08/17/2016' 324 E. New York Street Invoice# 00-28928 d Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD F- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due 08/08/16 Allen Brad A. Com rehensive Physical Exam 102.46 102.46 Res irator/Medical Review $16.73 $16.73 OnMed Pro ram 0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT Di ital 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W1 Inte 20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Anderson,Donovan Cory Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec IMD Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Butts Renee L. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Treadmill-Submax 0$159.90 159.90 Bod Fat Test-BIA Bio-Elec Im An14.6Chest X-Ra -PA/LAT Di ital 62.73Vital Si ns-HT WT BP P RVision-Acuit PFT-Pulmona Function TestAudio et 14.6 Public Safety Medical - INVOICE 0 Public Safety.Medical Invoice Date: 08/17/2016 324 E. New York Street Invoice# 00-28928 m Suite 300 Terms: �r W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD F- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due EKG W/Inte 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Deitsch Marc W. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Aporaisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Grimes Jeffrey A. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Hemoccult $0.00 $0.00 Haus Joshua S. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuily $27.18 $27.18 Public Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/17/2016 i 324 E. New York Street Invoice# 00-28928 ESuite 300 Terms: a� Indianapolis, IN 46204 ISM C Carmel Fire Department/CARMEFD F- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Hensley,Robert P. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult 0.00 0.00 Treadmill-Submax 159.90 159.90 BodyFat Test-BIA Bio-Elec ImpAnal 14.64 14.6 Chest X-Ray-PA/LAT Di ital 62.73 62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 Marvel Thomas L. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Anpraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Imo Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) $62.73 $62.7 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14. EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Medlen Michael J. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.731 OnMed Program $0.00 0.00 Health Risk AnDraisal Motivation 0.00 0.00 Treadmill-Submax $159,90 159.90 Public Safety Medical - INVOICE F Public Safety Medical Invoice Date: 08/17/2016 324 E. New York Street Invoice# 00-28928 0Suite 300 Terms: � W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD F- Denise Snyder, Budget&Accred Mgr M 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digi a] $62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Phillips,Craig M. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Apnraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) $62.73 $62.7 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Re ert Ian T. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Intem $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 W ant Andrew D. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Public"Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/17/2016 r 324 E. New York Street Invoice# 00-28928 E Suite 300 Terms: M Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD I- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Health Risk Anoraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ra -PA/LAT(Digital) $62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Inte 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 08109/161 Haymaker.Samuel K. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 BodV Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Inte 20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 Hoffman Matthew F. Com rehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Marcum Bradley D. Commehensive Physical Exam 102.4 102.46 Public Safety Medical - INVOICE to Public Safety Medical Invoice Date: 08/17/2016 ; 324 E. New York Street Invoice# 00-28928 E Suite 300 W Indianapolis, IN 46204 Terms: C Carmel Fire Department/CARMEFD H Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Sign -HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Inte 20.91 $20.91 Urinal sis-Di stick $3.14 $3.14 Osborne Scott K. Com rehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bod Fat Test-BIA Bio-Elec Im Anal 14.64 $14.6 Chest X-Ray-PA/LAT Di ital 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Inte 20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Plumer,Charles J. Comprehensive Ph sical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 0.00 Treadmill-Submax 159.90 159.90 BodyFat Test-BIA Bio-Elec Im Anal 14.64 14.6 Chest X-Ray-PA/LAT(Digital) 62.73 62.73 Vital Signs-HT WT BP P R 0.00 0.00 Vision-Acuity27.18 27.18 PFT-PulmonaryFunction Test 34.50 $34.50 Audiomet 14.64 14.6 EKG W me 20.9 20.91 Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/17/2016 324 E. New York Street Invoice# 00-28928 ¢'F E Suite 300 Terms: w Indianapolis, IN 46204 ' C Carmel Fire Department/CARMEFD _I- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Urinalysis-Di stick $3.14 $3.14 Rohr,Christopher M. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Inte 20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Schooley Dustin D. Comprehensive Physical Exam $102.46 1 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Imp Anal 14.64 14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Sher Adam C. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 16.7 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) E62.73 62.73 Vital Signs-HT WT BP P R 0.00 0.00 Vision-Acuity27.18 27.18 PFT-Pulmonary Function Test 34.50 34.50 Public` Safety Medical - INVOICE t°- Public Safety Medical Invoice Date: 08/17/2016 324 E. New York Street Invoice# 00-28928 E Suite 300 Terms: W Indianapolis, IN 46204 .� ...E c Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 9990. Date Employee Description AmountBalance Due Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Sombke Brad D. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 1 $20.91 Urinalysis-Dipstick $3.14 $3.14 ERespirator/Medical st X-Ray-PA/LAT(Digital) $62.73 62.73 Sutton Sean B. m rehensive Physical Exam 102.46 102.46 Review 16.73 16.73Med Pro ram 0.00 0.00 lth Risk Appraisal Motivation 0.00 0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Hemoccult $0.00 $0.00 Weaver Virgil L. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imo Anal 14.64 $14.6 Chest X-Ray-PA/LAT Di ital 62.73 $62.73 Public Safety Medical - INVOICE 0 Public Safety Medical Invoice Date: 08/17/2016 324 E. New York Street Invoice# 00-28928 ,,��, E Suite 300 Terms: 1% Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD H Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiornetry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Wendzel Jason D. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax 159.90 159.90 Bad Fat Test-BIA Bio-Elec Im Anal 14.64 14.64 Chest X-Ra -PA/LAT(Digital) 62.73 62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acui $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiornetry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.1141 08/10/16 Butts Joseph A. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax 159.90 $159.90 Bodv Fat Test-BIA Bio-Elec Im Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 27.1 PFT-Pulmonary Function Test 34.50 34.50 Audiomet 14.64 14.6 EKG W/Inte 20.91 20.91 Urinalysis-Dipstick 3.14 3.14 Cox Justin M. Com rehensive Physical Exam 102.46 102.46 Res irator/Medical Review 16.73 16.73 OnMed Pro ram 0.00 0.00 Health Risk Ann--:--' Motivation 0.00 0.00 Public, Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/17/2016 a 324 E. New York Street Invoice# 00-28928 E Suite 300 lY Indianapolis, IN 46204 Terms: 3 C Carmel Fire Department/CARMEFD F- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due EdFa Submax 159.90 159.90 est-BIA Bio-Elec Im Anal $14.64 $14.6-PA/LAT Di ital $62.73 $62.73 -HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Fuchs Jeffery W. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 On Med Program $0.00 $0.00 Health Risk Aonraisal Motivation 0.00 $0.00 Hemoccult $0.00 1 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Griffin Timothy M. Com rehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ra -PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp 1 $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Mead Jr. Donald R. I Comprehensive Physical Exam 102.46 102.46 Public` Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/17/2016 324 E. New York Street Invoice# 00-28928 E Suite 300 Terms: w Indianapolis, IN 46204 m c Carmel Fire Department/CARMEFD F� Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 BodV Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 ALidiometry $14.64 $14.6 EKG W/Interip $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Nicle ,Wes W. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Intern 20.91 $20.911 Urinalysis-Dipstick $3.14 $3.14 Robinson Mitchell L. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Im Anal $14.64 $14. Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 27.18 PFT-Pulmonary Function Test $34.50 34.50 Audiometry 14.64 14.6 Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/17/2016 i ~. 324 E. New York Street Invoice# 00-28928 s` ° E Suite 300 Terms: 0� Indianapolis, IN 46204 $. h. C Carmel Fire Department/CARMEFD �- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due EKG W/Inte 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Spelbring,James E. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Tierney,Scott A. Comprehensive Ph sical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Hemoccult $0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.141 08/11/16 Alverson Jonathan L. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax 159.90 159.90 BodyFat Test-BIA Bio-Elec ImpAnal 14.64 14.6 Chest X-Ray-PA/LAT Di ital 62.73 62.73 Vital Signs-HT WT BP P R 0.00 0.00 Public' Safety Medical - INVOICE ro Public Safety Medical Invoice Date: 08/17/2016 _ 324 E. New York Street Invoice# 00-28928 E Suite 300 Terms: W Indianapolis, IN 46204 t O Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Harrington,Adam C. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Im Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-AcuitV $27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 Audiometry $14.64 14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Holden Adam D. Comprehensive Physical Exam $102.46 $102.461 Respirator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Bod Fat Test-BIA Bio-Elec Im Anal 14.64 $14.64 Chest X-Ray-PA/LAT Di ital 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 AudiometrV $14.64 $14.64 EKG W/Interp $20.91 $20.911 Urinal sis-Dipstick $3.14 $3.14 Mueller William C. Com rehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 1 0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14. 4 $14.64 Public, Safety Medical - INVOICE t°- Public Safety Medical Invoice Date: 08/17/2016 ( *' _ 324 E. New York Street Invoice# 00-28928 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD F- Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Intem $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Phillips,Michael J. Com rehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.6 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 Watts Trent E. Comprehensive Physical Exam $102.46 $102.46 Res irator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Aonraisal Motivation 0.00 $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity $27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 AudiometrV $14.64 $14. EKG W/Interp $20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Weddin ton Kurt L. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation) $0.00 $0.00 Public` Safety Medical - INVOICE to Public Safety Medical Invoice Date: 08/17/2016 324 E. New York Street Invoice# 00-28928 1= Suite 300 Terms: w Indianapolis, IN 46204 " c Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr M 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.6 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-AcuitV $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.141 Zeller.Michael J. Comprehensive Physical Exam $102.46 $102.46 Respirator/Medical Review $16.73 $16.73 OnMed Pro ram $0.00 $0.00 Health Risk Avoraisal Motivation) $0.00 Treadmill-Submax $159.90 $159.90 Body Fat Test-BIA Bio-Elec Imp Anal $14.64 $14.64 Chest X-Ray-PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 $0.00 Vision-Acuity 27.18 $27.18 PFT-Pulmonary Function Test $34.50 34.50 Audiometry 14.64 14.6 EKG W/Interp $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.141 Total Charges-> $18,730.03 Total Payments&Balance Due->1 $0.001 $18,730.03 Please write invoice number on payment check. Our Federal Employer identification number is 35-2079797. We greatly appreciate the opportunity to serve you. If you have any questions regarding this invoice, please contact Debbie Pieper at 317-964-2330. VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER PUBLIC SAFETY MEDICAL SERVICES 324 E NEW YORK ST SUITE 300 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show!kind of service,where performed,dates service INDIANAPOLIS, IN 46204 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $800.66 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Carmel Police Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 00-28929 43-407.01 $800.66 1 hereby certify that the attached invoice(s),or 8/17/16 00-28929 pre employement testing-Valentine $800.66 1110 101 1110 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,August 23,2016 Tim Green Chief of Police 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 08/17/2016 r 324 E. New York Street Invoice# 00-28929 . E Suite 300 Terms: µ 1% Indianapolis, IN 46204 C Carmel Police Department/CARMEPD F- Attn: Pat Young m 3 Civic Square Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due 08/11/16 Valentine Patrick L. Res irator Clearance-SS $25.00 $25.00 Chart Review/Completion $91.20 $91.20 Indiana PERF Exam $204.93 $204.93 Drug Screen 9 +Opiates&Oxycodone $45.05 $45.05 Tonomet Glaucoma Test 40.54 $40.5 Urinalysis-Dipstick $3.39 $3.39 EKG W/Interp $22.52 $22.52 Audiometry 15.77 $15.7 PFT-PulmonarV Function Test $37.16 37.16 Vision-Color Ishihara 29.28 $29.28 Vision-Acuity 29.28 $29.28 Vital Signs-HT WT BP P R $0.00 $0.00 Veni uncture $3.39 $3.39 Applicant Blood Panel-PERF $129.29 $129.29 Quantiferon-Tb Blood $56.30 $56.30 Chest X-Ray-PA/LAT(Digital) $67.56 $67.56 Total Charges-> $800.66 Total Payments&Balance Due-> $0.00 $800.66 Please write invoice number on payment check. Our Federal Employer identification number is 35-2079797. We greatly appreciate the opportunity to serve you. If you have any questions regarding this invoice, please contact Debbie Pieper at 317-964-2330.