319986 12/21/17 CITY OF CARMEL, INDIANA VENDOR: 00350364
o".
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $***"*1,924.41
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK NUMBER: 319986
INDIANAPOLIS IN 46204 CHECK DATE: 12/21/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 0031384 200.93 MEDICAL EXAM FEES
1110 4340701 0031710 1,695.83 MEDICAL EXAM FEES
1110 4340701 0031750 27.65 MEDICAL EXAM FEES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 00350364 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PUBLIC SAFETY MEDICAL SERVICES IN SUM OF$ 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
$1,924.41
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
00-31710 43-407.01 $1,695.83 1 hereby certify that the attached invoice(s),or 12/6/17 00-31710 Keppler/Miller $1,695.83
1110 101 1110 101
00-31384 43-407.01 $200.93 bill(s)is(are)true and correct and that the 12/6/17 00-31384 Snow-Fit for Duty $200.93
1110 101 materials or services itemized thereon for 1110 1 101
I 00-31750 I 43-407.01 I $27.65 12/6/17 I 00-31750 I Miller Repeat Glucose I $27.65
1110 101 which charge is made were ordered and 1110 101
received except
Wednesday, December 13,2017
Jim Barlow
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
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Public Safety Medical - INVOICE
io P,ublic'Safety Medical Invoice Date: 09/201201.7
_ 324 E.New YorkStreet Invoice#' 00=31384
E Suite 300. Terms:
Indianapolis, IN 46204 W
I
f Carmel Police Department!CARMEPD
i
112'' Tgreen@carmel.In.Gov (SS).
oo Pyoung@carmel.ln.Gov (W)
1
Exclusively Serving Public Safety Professionals Since 1990.
,
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i Date. Employee" "Desoripton Amount. 13alancea]ue:
0_1 7 _ Duty Ex nl i 1 ..
total CFiarges->:
$200 93. ..
Total Pa ants 9 8alanee Due-> r$0.00= $200.93'
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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 th'is`invoice, please eohtact
Michelle McClure at 317=964-2364:
Public Safety Medical - INVOICE
Public Safety Medical Invoice Date: 11108/2017
.324 E.N6W York Street
Invoice# 00=31710
E. Suite 300
Terms:
lz Indianapolis,,IN 46204
Carmel Polite Department/CARMEPD
Tgreen@carmel.in.Gov (SS)
@ Pyoung@carmel.1n.Gov (W)
Exclusively Serving Public Safety Professionals Since 1990.
Date Employee. Affibdnii -Balanide'Dde.
11/01r.JerryE. Resolrator Cl arance-SS $26.00 $2&0
Chart Rwiew/CbmPl6tion 94:85 94.85
Indiana PERF Exam .'$213.13 $218.13
Druq,S6redn(9)*00lates;&Ox codons $46.85 $46.8
Ton6nietry(Glaucoma Test) $42.16 :$42.161
Uthalviis wDipstick $3.55 $3.53
EKG WJ Inten) $23.42
$23.42
AudiftetrV $16.40 $16.4
-Fff---P-u-*onary Function Test 38.65 38:6
Vision-:Color
$30.45
Vision w c_' -$30,45 $30.45
$0,00 $
Vital 81 P R 0,00
Venlounclure, 3153
$3.53
Abr)llbdnt Blood Panel PERF $134A $134.46
Quanfiferon-Tb(Blood) $58.55 $58; 5
Vision.-Color.(FanIsWorth) $30.45 $30.461
Chest X-Ray-PAIAT(Dinital) $70.26 $70:2
Millet,Joel D. -Respirator Clearance-SS $26.00 326.00
Chaff Rev6wlCompletion $94.85 -$94.85
'Indiana PERF Exam $213.13
$213.13
Drug Screen(9)+Or)lates&Oxycodone $46.96 :$46.85
TonomeirylGfaucoma test! $42.16 `42.11
UO alysis-D' stic 9. 3 3.53
EKG Interr) $23.42
Aud 0 omg-tEy �16.40 .$i6;40
PFT-Pulmonary Function Test $38.65 '$38;6
Vision-.Color(Ishihara) $30.45 30.45
0'
Vision-AcuitV $30A 30.45
Vision
0.0()
Vital 8i ns-W WT BP P R $0.00 0.00
VenlDuncture $3.53 $3.53
Aonlicant blood Panel I-PERF' $134.46 $134.46
Quantiferon-Tb
b tBlood) $5 58:5 $0.551
Chest X-Ray-PAILAT(bi-gital) $70.26 �70�.26
Total.Charges .$1,696.n
11
Total Payments&Balance Due $0:00 $1.695.83
Public Safety Medical - INVOICE
0 Public Safety Medical Invoice Date: 11/17/2017
3.24 E.New York Street lnv6ice# 00-31750
E Suite 300 Terms:
Indianapolis,IN 46204
o Carmel Police Department CARIVIEPD
Tgreen@carmel.1n.Gov (SS)
5
j Pyoung@0ar 1.1 . v '(W)
meGo,
n
Exclusively Serving Public Safety Professionals Since 1990.
MW- 1Employee DesMOfion
Amount 2Balbil6e DueA11ar Inal ktQti 24.1
S24.12
Venibuncture $3.53 $3 Fq
Total Charges_-> $27,651
Total Payments&Balance Due 40.00 1 $27.65
.651
Please write invoice number on payment check. Our Fed.eral.Employer ident.ification.-numbe'r is 35m2079797.
We greatly appreciate the opportunity to serve you. If you have anyquestioris regarding this invoice, please contact
Michelle McClure at 317-964-2364.