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Home My WebLink About304738 10/31/16 %'F��f. _ CITY OF CARMEL, INDIANA VENDOR: 00350364 ® ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $....12,336.69* 4. _� CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 304738 9.y,��oN�` INDIANAPOLIS IN 46204 CHECK DATE: 10/31/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 00-29192 7,096.02 MEDICAL EXAM FEES 1120 4340701 00-29239 4,730.68 MEDICAL EXAM FEES 1120 4340701 24831 00-29292 53.16 DEPARTMENT PHYSICALS 1120 4340701 00-29334 456.83 MEDICAL EXAM FEES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) PUBLIC SAFETY MEDICAL SERVICES ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 324 E NEW YORK ST SUITE 300 IN SUM OF$ 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. $11,826.70 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# 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 29192 43-407.01 $7,096.02 1 hereby certify that the attached invoice(s),or 10/13/16 29239 $4,730.68 1120 101 1120 101 29239 43-407.01 $4,730.68 bill(s)is(are)true and correct and that the 10/13/16 29192 $7,096.02 1120 1 1 101 materials or services itemized thereon for 1120 1 101 which charge is made were ordered and received except Thursday, October 13, 2016 D40a --zt 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 5-11-10-1.6 120— Cost 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 09/29/2016 r 324 E. New York Street Invoice# 00-29192 _ m 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 09/22/16 Allen John P. 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 $40.54 Urinalysis-Dipstick $3.39 $3.39 EKG W/Interp $22.52 $22.52 Audiometry 15.77 $15.77 PFT-Pulmonary 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 PSY-Applicant Psych Eval $382.01 $382.01 Andres Jr Victor S. Respirator Clearance-SS $25.00 $25.00 Chart Review/Completion $91.20 $91.201 Indiana PERF Exam $204.93 $204.93 Drug Screen 9 +Opiates&Oxycodone $45.05 $45.05 Tonometry Glaucoma Test $40.54 $40.5 Urinalysis-Dipstick $3.39 $3.39 EKG W/Intero $22.52 $22.52 Audiometry 15.77 $15.77 PFT-Pulmonary Function Test $37.16 $37.16 Vision-Color Ishihara $29.28 $29.28 Vision-Acuity $29.28 29.28 Vital Si ns-HT WT BP P R 0.00 0.00 Veni uncture 3.39 3.39 A licant Blood Panel-PERF 129.29 129.29 Quantiferon-Tb Blood 56.30 56.30 Chest X-Ra -PA/LAT(Digital) 67.56 $67.56 PSY-Applicant Psych Eval $382.01 $382.01 DeR ckere Matthew Respirator Clearance-SS $25.00 $25.00 Chart Review/Com letion $91.20 $91.201 Indiana PERF Exam 204.93 $204.931 Public Safety Medical - INVOICE t° Public Safety Medical Invoice Date: 09/29/2016 324 E. New York Street Invoice# 00-29192 E Suite 300 W Indianapolis, IN 46204 Terms: "' " '- r 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 EEKG Screen 9 +O fates&Oxycodone 45.05 45.0 met Glaucoma Test $40.54 $40.5 sis-Dipstick $3.39 $3.39 W/Inte $22.52 $22.5 AudiometrV $15.77 $15.77 PFT-Pulmonary 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 Venipuncture $3.39 $3.39 Applicant Blood Panel-PERF $129.29 $129.29 uantiferon-Tb Blood 56.30 $56.30 PSY-Anplicant Psych Eval $382.01 $382.01 Chest X-Ray-PA/LAT(Digital) $67.56 $67.56 Graves Glenn C. Respirator Clearance-SS $25.00 $25.00 Chart Review/Completion $91.20 $91.20 Indiana PERF Exam $204.93 $204.93 Drua Screen 9 +Opiates&Ox codone $45.05 $45.05 Tonometry Glaucoma Test 40.54 $40.54 Urinalysis-Dipstick $3.39 $3.39 EKG W/Intem $22.52 $22.52 Audiomet $15.77 $15.7 PFT-Pulmonary Function Test $37.16 $37.16 Vision-Color Ishihara 29.28 $29.28 Vision-Acuity 29.28 $29.2 Vital Signs-HT WT BP P R $0.00 $0.00 Venipuncture $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 PSY-Applicant Psych Eva[ $382.01 $382.01 09/23/16 Finn David S. Res irator Clearance-SS $25.00 $25.00 Chart Review/Completion $91.20 $91.20 Indiana PERF Exam $204.93 $204.93 Chest X-Ray-PA/LAT(Digital) 67.56 $67.56 Drug Screen 9 +Opiates&Ox codone $45.05 $45.05 Tonometry Glaucoma Test 40.54 $40.5 Public Safety Medical - INVOICE F°- Public Safety Medical Invoice Date: 09/29/2016 r 324 E. New York Street Invoice# 00-29192 E Suite 300 Terms: - W Indianapolis, IN 46204 r 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 9990. Date Employee Description Amount Balance Due Urinalysis-Di stick $3.39 $3.39 EKG W/Interp $22.52 $22.52 Audiometry $15.77 $15.7 PFT-Pulmonary 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 Venipuncture $3.39 $3.39 Applicant Blood Panel-PERF $129.29 $129.29 Quantiferon-Tb Blood 56.30 $56.30 PSY-Aoplicant Psych Eval $382.01 $382.01 Joehl Carson M. Respirator Clearance-SS $25.00 $25.00 Chart Review/Com letion $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/Intem $22.52 $22.52 Audiometry 15.77 $15.7 PFT-Pulmonary Function Test $37.16 $37.16 Vision-Color Ishihara 29.28 $29.28 Vision-Acuity 29.28 $29.28 Vital Si ns-HT WT BP P R $0.00 $0.00 Veni uncture $3.39 $3.39 Apolicant Blood Panel-PERF $129.29 $129.29 Quantiferon-Tb Blood $56.30 $56.30 Chest X-Ray-PA/LAT(Digital) $67.56 $67.56 PSY-Applicant Psych Eval $382.01 $382.01 Total Charges->1 $7,096.02 Total Payments&Balance Due->1 $0.00 $7,096.02 Public Safety Medical - INVOICE s o Public Safety Medical Invoice Date: 09/29/2016 r 324 E. New York Street Invoice# 00-29192 E Suite 300 Terms: 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 I Balance Due 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. Public Safety Medical - INVOICE G. I°- Public Safety Medical Invoice Date: 10/06/2016 . 324 E. New York Street Invoice# 00-29239 Suite 300 Terms: "W 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' 09/26/16 Dailey,Robert A. 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 Tonometry 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-Pulmonary Function Test $37.16 $37.16 Vision-Color Ishihara 29.28 $29.28 Vision-Acuity 29.28 $29.28 Vital Si ns-HT WT BP P R $0.00 $0.00 Veni uncture $3.39 $3.39 Applicant Blood Panel-PERF Ed $129.29 $129.29 Quantiferon-Tb Blood $56.30 $56.30 Chest X-Ray-PA/LAT(Digital) $67.56 $67.56 PSY-Applicant Psych Eva[ $382.01 $382.01 Eischen Kyle J. Respirator Clearance-SS $25.00 $25.00 Chart Review/Completion $91.20 $91.201 Indiana PERF Exam $204.93 $204.93 Drua Screen 9 +Opiates&Ox codone $45.05 $45.05 Tonometry Glaucoma Test $40.54 $40.5 Urinalysis-Di stick $3.39 $3.39 EKG W Intero $22.52 $22.52 Audiometry 15.77 $15.77 PFT-Pulmonary Function Test $37.16 $37.16 Vision-Color Ishihara $29.28 $29.28 Vision-AcuitV $29.28 $29.28 Vital Signs-HT WT BP P R $0.00 $0.00 Venipuncture $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 PSY-Applicant Psych Eval $382.01 $382.01 Smith David M. Respirator Clearance-SS $25.00 $25.00 Chart Review/Completion $91.20 $91.20 Indiana PERF Exam $204.93 $204.93 Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 10/06/2016 �_. 324 E. New York Street Invoice# 00-29239 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 Druo Screen 9 +O iates&Oxycodone $45.05 $45.05 Tonometry 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-Pulmonary 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 tVenbuncture 3.39 3.39 ood Panel-PERF 129.29 129.29 -Tb Blood 56.30 56.3-PA/LAT Di ital 67.56 67.56 cant Psych Eval $382.01 $382.01 09/28/16 Butts Andrew P. Respirator Clearance-SS $25.00 $25.00 Chart Review/Completion $91.20 $91.20 Indiana PERF Exam $204.93 $204.93 Drug Screen 9 +Opiates&Ox codone $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-Pulmonary Function Test $37.16 $37.16 Vision-Color(Ishiharal $29.28 $29.28 Vision-Acuity 29.28 $29.28 Vital Signs-HT WT BP P R $0.00 $0.00 Venipuncture $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 PSY-Applicant Psych Eval $382.01 382.01 Total Charges-> $4,730.68 Total Payments&Balance Due-> $0.001 $4,730.68 Public Safety Medical - INVOICE a . , 12 Public Safety Medical Invoice Date: 10/06/2016 324 E. New York Street Invoice# 00-29239 E Suite 300 I= Indianapolis, IN 46204 Terms: 4 C Carmel Fire Department/.CARMEFD Denise Snyder, Budget&Accred Mgr m 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due Please write invoice number on payment check. Our Federal Employer identification number is 35-2079797. We greatly appreciate the opportunity to serve you. If you have any questions regarding this invoice, please contact Debbie Pieper at 317-964-2330. VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995) PUBLIC SAFETY MEDICAL SERVICES ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 324 E NEW YORK ST SUITE 300 IN SUM OF$ 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. $53.16 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 28491 29292 43-407.01 $53.16 1 hereby certify that the attached invoice(s),or 10/24/16 29292 $53.16 1120 101 1120 101 Mn 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 24,2016 David Haboush Fire Chief 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 F Public Safety Medical Invoice Date: 10/13/2016 324 E. New York Street Invoice# 00-29292 �E Suite 300 Terms: IY Indianapolis, IN 46204 " c Carmel Fire Department/CARMEFD I-- Denise Snyder, Budget&Accred Mgr -o0 2 Civic Square(PO#24831) Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date— Employee Description'—i Amount Balance-Due 10/03116 Dailey,Robert A. Veni uncture $3.39 $3.39 Repeat Glucose Fastin Blood $23.19 $23.19 10/04/16 Eischen Kyle J. Venipuncture $3.39 $3.39 Repeat—Glucose, Fastin Blood 23.19 $23.19 Total Charges-> $53.16 Total Payments&Balance Due->1 $0.001 $53.16 Please write invoice number on payment check. Our Federal Employer identification number is 35-2079797. We greatly appreciate the opportunity to serve you. If you have any questions regarding this invoice, please contact Debbie Pieper at 317-964=2330. VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) PUBLIC SAFETY MEDICAL SERVICES ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 324 E NEW YORK ST SUITE 300 IN SUM OF$ 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. $456.83 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 29334 43-407.01 $456.83 1 hereby certify that the attached invoice(s),or 10/24/16 29334 $456.83 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, October 24,2016 Va"ar --zt- 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 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 10/20/2016 324 E. New York Street Invoice# 00-29334 Suite 300 IX Indianapolis, IN 46204 Terms: a 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 9990. -Date Ern}3loyee - Description-"- - Amount- Batance t7ue -- - - 10/10/16 Bowles Orbie H. 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 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 Inte 20.91 $20.91 Urinalysis-Di stick $3.14 $3.14 10/ ndwa No-ShGw-Fee-- Total Charges-I -V96.83 Total Payments&Balance Due->1 $0.00 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.