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Home My WebLink About308235 02/13/17 `•�u!.4!1gyf( CITY OF CARMEL, INDIANA VENDOR: 00350364 ® �j ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $""*"2,495.00' ?� CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 308235 9�y�TON... INDIANAPOLIS IN 46204 CHECK DATE: 02/13/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 100018 0029843 2,495.00 OFFICER PHYSICALS VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 00350364 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER PUBLIC SAFETY MEDICAL SERVICES IN SUM OF$ CITY OF CARMEL 324 E NEW YORK ST SUITE 300 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. INDIANAPOLIS, IN 46204 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Carmel Police Terms Date Due �0#� ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT I hereby certify that the attached invoice(s),or 1/12/17 00-29807 officer physicals $1,168.94 1110 101 1110 101 100018 00-29843 43-407.01 $2,495.00 bill(s)is(are)true and correct and that the 1/19/17 00-29843 officer physicals $2,495.00 1110 101 materials or services itemized thereon for 1110 1 101 which charge is made were ordered and received except Wednesday, February 01,2017 Green,Tim 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 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Public Safety Medical - INVOICE H Public Safety Medical Invoice Date: 01/19/2017 324 E. New York Street Invoice# 00-29843 d Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Police Department/CARMEPD Chief Tim Green-(PO 34162) m 3 Civic Square Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. -Date --Employee-- - -= ---Description=-=----- -Amount---Balance-Due- 01/09/17 Dawson Gregory F. OnMed Pro ram $0.00 $0.00 Respirator/Medical Review $18.74 $18.7 Health Risk Appraisal Motivation $0.00 $0.00 Comprehensive Ph sical Exam $114.77 $114.77 Waist/Hi Ratio $3.53 $3.53 BodV Fat Test-BIA Bio-Elec Imp Anal 16.40 16.40 Treadmill-Submax $179.11 $179.11 Flexibility Test $11.72 $11.72 Urinalysis-Di stick $3.53 $3.53 EKG W/Inte 23.42 $23.42 Audiometry 16.40 16.40 PFT-Pulmonary Function Test $38.65 $38.65 Vision-Acuity 30.45 $30.45 Vital Signs-HT WT BP P R $0.00 $0.00 Fisher Charles B. OnMed Program $0.00 $0.00 Respirator/Medical Review $18.74 $18.74 Health Risk Appraisal Motivation 0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Waist/Hi Ratio $3.53 $3.53 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 16.40 Treadmill-Submax $179.11 179.11 Muscular Strength Endurance Test $30.45 $30.45 Flexibility Test $11.72 $11.72 Urinal sis-Di stick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry $16.40 $16.40 PFT-Pulmonary Function Test $38.65 $38.6 Vision-Acuity $30.45 $30.45 Vital Signs-HT WT BP P R $0.00 $0.00 Hill Nathaniel W. OnMed Program $0.00 $0.00 Respirator/Medical Review $18.74 $18.7 Health Risk Argraisal Motivation 0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Waist/Hi Ratio $3.53 $3.53 Body Fat Test-BIA Bio-Elec Im Anal 16.40 $16.40 Treadmill-Submax $179.11 $179.11 Muscular Strenoth E du a ce Test $30.45 $30.45 Public Safety Medical - INVOICE t°- . Public Safety Medical Invoice Date: 01/19/2017 324 E. New York Street Invoice# 00-29843 E Suite 300 Terms: W Indianapolis, IN 46204 o Carmel Police Department/CARMEPD Chief Tim Green(PO 34162) m 3 Civic Square Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990.- Date=- Employee-. ------ '-DescPiption'- - Amount -Balance Due- Flexibili Test $11.72 $11.72 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.40 PFT-Pulmonary Function Test $38.65 $38.65 Vision AcuitV $30.45 $30.45 Vital Signs-HT WT BP P R $0.00 $0.00 Loveall Gregory A. OnMed Program $0.00 $0.00 Respirator/Medical Review $18.74 $18.74 Health Risk Appraisal Motivation 0.00 $0.00 Comprehensive Physical Exam $114.77 114.77 Waist/Hi Ratio $3.53 $3.53 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 $16.40 Treadmill-Submax $179.11 $179.11 Muscular Strength Endurance Test $30.45 $30.45 Flexibili Test $11.72 $11.72 Urinalysis-Dipstick $3.53 $3.53 EKG W/Interp $23.42 $23.42 Audiometry 16.40 $16.40 PFT-Pulmonary Function Test $38.65 38.65 Vision-Acuity 30.45 $30.45 Vital Si ns-HT WT BP P R $0.00 $0.00 Snow. Donald C. No Show Fee $44.80 44.80 Theis Adam G. No Show Fee $44.80 $44.80 White II Robert E. On Med Pro ram $0.00 $0.00 Respirator/Medical Review $18.74 $18.7 Health Risk Appraisal Motivation $0.00 $0.00 Comprehensive Physical Exam $114.77 $114.77 Waist/Hi Ratio $3.53 $3.53 Body Fat Test-BIA Bio-Elec Imp Anal 16.40 16.40 Treadmill-Submax $179.11 $179.11 Muscular Strength Endurance Test $30.45 $30.45 Flexibility Test $11.72 $11.72 Urinalysis-Dipstick $3.53 $3.53 EKG W/Inte 23.42 $23.42 Audiometry 16.40 16.40 PFT-Pulmonary Function Test .65 It38 65 Public Safety Medical - INVOICE o. Public Safety Medical Invoice Date: 01/19/2017 324 E. New York Street Invoice# 00-29843 E Suite 300 Terms: W Indianapolis, IN 46204 C Carmel Police Department/CARMEPD Chief Tim Green(PO 34162) m 3 Civic Square Carmel, IN 46032 Exclusively Serving Public Safety Professionals Since 1990. Date -`T --Employee - - --Description -Amouht—-Balance Due Vision Acuity 30.45 30.45 Vital Si ns-HT WT BP P R $0.00 $0.00 Total Charges->1 $2,495.00 Total Payments&Balance Due=>1 $0.00 $2,495.00 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.