308235 02/13/17 `•�u!.4!1gyf( CITY OF CARMEL, INDIANA VENDOR: 00350364
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ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $""*"2,495.00'
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CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 308235
9�y�TON... INDIANAPOLIS IN 46204 CHECK DATE: 02/13/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 100018 0029843 2,495.00 OFFICER PHYSICALS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 00350364 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PUBLIC SAFETY MEDICAL SERVICES IN SUM OF$ 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.