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Home My WebLink About305647 11/28/16 a u1.Flay �/ ,? CITY OF CARMEL, INDIANA VENDOR: 00350364 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $.*`. 1,474.51 f ,?� CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 305647 +M.,_�, INDIANAPOLIS IN 46204 CHECK DATE: 11/28/16 t �tON DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 24831 29447 663.31 DEPARTMENT PHYSICALS 1120 4340701 24831 29487 811.20 DEPARTMENT PHYSICALS VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) PUBLIC SAFETY MEDICAL SERVICES ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 324 E NEW YORK ST SUITE 300 IN SUM OF$ 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. $663.31 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 29447 43-407.01 $663.31 1 hereby certify that the attached invoice(s),or 11/18/16 29447 $663.31 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 Friday, November 18, 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 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 11/10/2016 324 E. New York Street Invoice# 00-29447e , E Suite 300 Terms: � Indianapolis, IN 46204 4.1 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. JDafe - Employee Description Amount Balance Due 10/31/16 Horner David W. 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 Bod Fat Test-BIA Bio-Elec Im Anal 14.64 14.6 CMP Com Metabolic Panel 20.00 20.00 CBC Com Blood Count 18.13 18.13 Li id Panel Blood 21.26 $21.26 Venipuncture $3.14 $3.14 HIV-4th Gen Rapid Test Blood 24.56 24.56 PSA-Prostate S ecific A Blood 36.59 36.59 Chest X-Ray-PA/LAT(Digital) 62.73 62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vision-Acuit $27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry $14.64 $14.6 EKG W/Interp 1 $20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 11/03/16 Hoffman Matthew F. Fitness For Duty Exam Initial Level 1 82.80 82.80 Total Charges-> $663.31 Total Payments&Balance Due-> ' $0.001 $663.31 Please write invoice number on payment check. Our Federal Employer identification number is 35-2079797. We greatly appreciate the opportunity to serve you. If you have any questions regarding this invoice, please contact Debbie Pieper at 317-964-2330. VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995) PUBLIC SAFETY MEDICAL SERVICES ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 324 E NEW YORK ST SUITE 300 IN SUM OF$ 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. $811.20 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 29487 43-407.01 $811.20 1 hereby certify that the attached invoice(s),or 11/21/16 29487 $811.20 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, November 21,2016 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 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Public Safety Medical - INVOICE o Public Safety Medical Invoice Date: 11/18/2016 324 E. New York Street Invoice# 00-29487 E Suite 300 Terms: " W Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD Denise Snyder, Budget&Accred Mgr 2 Civic Square(PO#24831) m Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 9990. - Date---.-....... - . .-Employee__ -_: ---- -=Description- - --_ _ 'Amount- Balance-Due---- -- --- 11/07/16 Johnson Jeremy S. 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/Inte 20.91 $20.91 Urinalysis-Dipstick $3.14 $3.14 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 $14.6 Chest X-Ray-PA/LAT Di ital 62.73 $62.73 11/10/16 Hu hes Chad L. 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 $14.64 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 Audiometry 14.64 $14.6 EKG W/Intem $20.91 $20.91 Urinal sis-Dipstick $3.14 3.14 Total Charges- $81'1.20 Total Payments&Balance Due-> $0.00 $811.20