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Home My WebLink About331227 10/17/18 CITY OF CARMEL, INDIANA VENDOR: 00350364 ® ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $***"*2,701.80* CARMEL, INDIANA 46032 6612 E.75TH STREET CHECK NUMBER: 331227 SUITE 200 CHECK DATE: 10/17/18 INDIANAPOLIS IN 46250 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 33704 1,801.20 MEDICAL EXAM FEES 1120 4340701 33761 900.60 MEDICAL EXAM FEES VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995) Vendor# 00350364 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER PUBLIC SAFETY MEDICAL SERVICES IN SUM OF$ CITY OF CARMEL 6612 E. 75TH STREET An invoice or bill to be properly itemized must show:kind of service,where performed,dates service SUITE 200 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. INDIANAPOLIS, IN 46250 Payee $2,701.80 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 33761 43-407.01 $900.60 1 hereby certify that the attached invoice(s),or 10/11/18 33761 FF Physicals $900.60 1120 101 1120 101 33704 43-407.01 $1,801.20 bill(s)is(are)true and correct and that the 10/11/18 33704 FF Physicals $1,801.20 1120 1 1 101 1 materials or services itemized thereon for 1120 101 which charge is made were ordered and received except Friday,October 12,2018 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 iso Public Safety Medical Invoice Date: 09/26/2018 6612 E.75th Street Invoice# 00-33704 ?^sY Floor 2 Terms: ' Indianapolis,IN 46250 fW Carmel Fire Department!CARMEFD ji Denise Snyder,Budget&Accred Mgr :5 Dsnyder@carmel.in.Gov(B) Exclusively Serving Public Safety Professionals Since 9990. r r.:.� r =-•••�j7 °}• ,,� ;rArsioMnfs'`�'��lalailca;f3 ate. .a... .....,�..........,�rnp oyes::,,_::_.:z,:;:..:,,,•:::>,;.�. :,�-;; 9 21/18 Rpnne.Jonathan R. Comprehensive Ph si I Exam $117.07 $117.07 Respirator/Medical Review $19.11 $19.11 OnMed Program $0.00 $0.00 Health Risk Appraisal Medikee er 0.00 $0.00 Med Opinion-Wellness t82.69 0.00 Med inion-Respirator 0.00 Treadmill-Submax 182.69 BodyFat Test-BIA Bio-Elec ImpAnal 16.73 Vital Si ns-HT WT BP P R $0.00 Vision-Acuity 1.06 $31.061 PFT-Pulmonary Function Test $39,42 $39.42 Au cometry sj&z16.73 EKgz W1 Intery23. $23.89 Urinal sis-Dipstick $3.60 $3.60 Frost Bruce S. Comprehensive Physical Exam $117.07 $117.07 Respire Wedical Review $19.11 $19.11 OnMed Program $0.00 $0.00 Health Risk Appraisal Medike er 0.00 $0.00 Med O inion-Wellness 0.00 $0.00 Med Opinion-Respirator $0.00 no Med O inion-Hazmat $0.00 0.00 Treadmill-Submax $182.69 182.69 Body Fat Test-BIA(Bio-Elec Imp Anal 16.73 $16.73 Vital Sions-HT WT BP P R $0.00 $0.00 Vision-Acuity .06 $31.G6 PFT-Pulmonary Function Test $39.42 $39.4 Audiometry $16.73 $16.73 EKG W!Interp $23.89 $23.89 Urinal sis-Dipstick $3.60 $3.60 Mason,Bryan L. Comprehensive Ph ical Exam $117.07 $11117.07 Rewlrator/Medlcal Review $19.11 $19.11 OnMed Program 0.00 $0.00 Health Risk Appraisal Medikee er 0.00 $0.00 Med Opinion-Wellness $0.00 90.00 Med Opinion-Respirator $0.00 $0.00 Treadmill-Submax 82.6 $J§2.69 B -B Bio- I $15.73 Public_ Safety Medical - INVOICE `o Public Safety Medical Invoice Date: 09126/2018 # „ ,... .. 6612 E.75th Street Invoice# 00-33704 =.RysFloor 2 'terms: Indianapolis,IN 46260 tfi:mt9i7 Carmel Fire Department/CARMEFD a Denise Snyder,Budget$Accred Mgr ;ar u Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 1990. .,. .._ ._...., :•>r....�..,,. �_--- ;..t..t> ..:<...,_&_�_,:,.t,••- .+L7 ion,�irT _ ' :_:-�[T14Un n. `�� -- Vital Signs-HI WT BP P R $0.00 Vision-Acuity $31.06 $31.0 PFT-Pulmonary Function Test $39.42 $39.4 Audiametry $16.73 $16.73 EKG W/Interp $23.89 $23.89 Urinal sis-di tick $3.60 $3.60 Russel Grant W. Comoehensive Physical Exam 1117.07 $117.0 Re irator/Medical Review $19.11 $19.11 OnMed Program $0.00 $0.00 Health Risk Aporaisal(Med ikeener) $0.00 $0.0 Med 0 i to -Wellness $0.00 $G.O Med Oninion-Resvirator $0.00 $0.00 Treadmill-Sub ax $182.69 9182.69 Bodv Fat Test-BIA Bio-Elec Imp AnalW31.06 $16.73. Vital Sl ns-HT WT BP P R 0.00 Vision-Acuity 1.0PFT-Pul o Fun tion Test 9.Audio et 1EKG W 1 ter $23.89 Urinalysis-DI stick 83.60 3.6 ....... _......-............;......: .. ._....._._. ..___.........�.... ._._..._........,..:!�:'.:�i•i...1'tD: - - - •:;I':t:.Y'.L.:tL::t:d�_;: :::::' :::4,:r-- - - .».•,z..,z..h.�,.L .....�.. ...�..�. i. .:....t..t.i.•..t.-.+.......t.A+!it "�:,k":.z's-:l'.at ,.ii,T.•:=':Y i':::.:: y'7�'�-L- iiL�i�ir.�!•.:.r�'-'�'[« ""t^.: ....... •j s'W �7. - PE t;:: t, ........z�,..•-^.c........._.._.;,..:er.„.•.t.;L'L..L?.'!!:mom;4.__-S::?�•:..._iw°La. ,.f Ls''s.',:e,,.tn�.F.Gi� n .S'" _ ,c' - .,: .,_astt. .,. .. ..t....A... .... .s'cL'rY:f=%i cam'..S_ ;`,:. r.�:.>`�t.�:.. I",a' :.�ifs� `�i3aiair'� �u' , �; 'iota °r)ie � , •. . ..�; :�_:.; 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 Michelle McClure at 317-964-2364. Public Safety Medical - INVOICE i_fFye Public Safety Medical Invoice Date: 10/0412018 �. 6612 E.75th Street SAY` Invoice# 00-33761 ' E Floor 2 Terms: lip Indianapolis,IN 46250 PIERRE Carmel Fire Department/CARMEFD iii w Denise Snyder,Budget&Accred Mgr Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 1990. -ei_C• -_-1•L�l]^_fit -:`i]2V.::iii _ _ _ _ ".1:�I'-:��-i_=�C-.-:l�' - .�s =a.�,::_.:!_.Iron l.¢.. e,�;�,FF �w�i:,.�.: ,.,�-:,,.,.:.: - 'sc �ioi�°�:!r�,F,!F!=��:...:.. �airx►�ni<,I�=` ��a[a._eelA.09125/18 Finn.David S. Com r nsive P s' I Exam $117.07 $117.07 Respirator/Medical Review $19.11 $19.11 OnMed Program $0.00 $0.00 Health Risk Appraisal Medikee er 0.00 $0.00 Med Opinion-Wellness $0.00 $0.00 Med Opinion-Res irator $0.00 $0.00 Treadmill-Submax $182.69 Body-Fat Test-BIA Bio-Elec Imp Anal 16.73 $16.73 Vital Si s-HT WT SP P R $0.00 $0.00 Vision-Acuity $31.06 $31.06 PFT-Pulmonary Function Test $39.42 9: 2 Audlorretry ..EKG W1 Intem3.89 $23.89 Urinalysis-Dipstick $3.60 $3.60 SmithDavid M. Comprehensive Physical Exam $117.07 $117.07 Res irator/Medical Review $19.11 19.11 OnMed Program $0.00 $0.00 Health Risk Appraisal Medikee er 0.00 $0.00 Med Opinion-Wellness $0.00 $0.00 Med Opinion-Respirator $0.00 $O.00 Treadmill-Sub ax $182.69 $182.69 Body Fat Test-BIA Bio-Else Im Ana 6.73 $16.73 Vital Signs-HT WT SP P 0.00 $0.00 Vision-Aculty $31.06 $31.06 PFT-Pulmonary Function Test $39.42 .42 Audiome $16:73 $16.73 EKG W/Interp $23.89 $23.89 Urina sis-Di stick $3.60 $3.60 .:]6MI 919:._._::_:. .,.5.,= �.�!m.oa..=A,. :•1::.,::••sna:•f i?I%ii: e =__`�,L;L•LI9RI:iiaf99k't:F'.C�O61��Gem2' ..:. °ue!Fa�zt93 a ¢,Ie.r,6�."� �ie!:i'i= .L•_•_.:],Erae9!6s„6•:,jA d -. �iG�a° u_11.1019=..::�: �!s�i,,,,.,�:,,..,r aiG .I.S•!¢mn'IFr,�i:. tr.;ri.=vwee:�¢�r99.. sn9l::,¢.., �ei9n!!Fx:-I :nu•v �a:, - 696S:r¢ F unlslna6Frai�„� ••ssn:9,r s.,5enr. 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