The URL can be used to link to this page

Home My WebLink About332331 11/13/18 CITY OF CARMEL, INDIANA VENDOR: 00350364 ® ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $-1',"*1,141.55* s9 a CARMEL, INDIANA 46032 6612 E.75TH STREET CHECK NUMBER: 332331 SUITE 200 CHECK DATE: 11/13/18 INDIANAPOLIS IN 46250 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 33908 602.99 MEDICAL EXAM FEES 1120 4340701 34006 538.56 MEDICAL EXAM FEES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 00350364 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER PUBLIC SAFETY MEDICAL SERVICES IN SUM OF$ CITY OF CARMEL 6612 E. 75TH STREET An invoice or bill to be property 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 $1,141.55 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 33908 43-407.01 $602.99 1 hereby certify that the attached invoice(s),or 11/6/18 33908 Physicals $602.99 1120 101 1120 101 34006 43-407.01 $450.30 bill(s)is(are)true and correct and that the 11/6/18 34006 Physical $450.30 1120 1 101 1 materials or services itemized thereon for 1120 1 101 I 34006 I 43-407.01 I $88.26 11/6118 I 34006 I RTW Evaluation I $88.26 1120 101 which charge is made were ordered and 1120 101 received except Tuesday, November 6,2018 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 ,20 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Public Safety Medica! - INVOICE is g �� Public Safety Medical Invoice Date: 11/01/2018 1 , 6612.E.75th Street Invoice# 00-34006 2� Floor - Terms: ` Indianapolis,IN 46250 F ` Carmel Fire Department/CARMEFD REk M Denise Snyder,Budget&Accred,Mgr w �Y Dsnyder@carmel.in.Gov(B) Exclusively Serving Public Safety Professionals Since 1994.. �:!'. .yH,,ea��m:r:axri=i�3R�c•,_�`:--.,••-ac .• erg:�=':.»'��',�5ic+.�ce�:7!'i:{icsx=?ked -a.:'::.cn....�'ai�4 •-�.:},ten'vi:�i.�C�,:�:',grr.<,;:�,.c.• x.2o:iP.ir..'..."n"i _ 71.,�...,�c:. ,-?��'��`SY trT��tY_ �. .�"..��a�z:a Ktu.. ��i.�i.�W._.��^ �m�tf t3, p�,� �y��,�••��e,-�ypa:< .., .... ,s' -.... .-,-.s.:1^S?:?:F:_:`�.•X>..... .�..�z.:.s��di?:v .,-..d .:..7 5i.._r,... ..�_<ai...,¢9-�1PI�4�,r..al.n„k•N� 10/29/18 Brant. et E. Fitnew For Duty ExamInitia Lave[1 $88.26 $88.26 Med Opinion-Fit For DutV $0.00 $0.00 Memev,Scott A. 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 O inion-Task Fo ce One 0.00 $0.00 Med O inion-Respirator 0.00 .od Med O in•on-Hazmat $0.00 $0.00 Hemoccult $0.00 $0.00 Treagmill-Submax $182.69 $182.6 Body t Test-B -Elec $16,73 $16, 3 Vital Signs-HT WT BP RR W$23.89 0.00 Vision-Acul $31.06 PFT-Pulmona Fundon Test 39.42 Audiometry 16.73 EKG W Ito 23.89 Urinalysis-Di stick $3.60 .60 0/31/18 Steele Je A. No Show Fee 0.00 0.00 i•e._;L:a^ •Y:.sy� L�ec7�:. �. :E.aei�i� u•�:.. yx,c,;�:y�'�..,a-mcurr..s::nnr:(i�•.-::r"::::Mc•::�uF x`;7P.:..�..y�.w;..;..m,ca;.; t',4ez•::� ^aan „e. r.5+i'.i:We... _- _s3R'S 5,... .� <r."YEs:�� ,-.�.:3��;�k� tti:.�.�,�xc•:,:-�r��t,•,��i-.r.�:•�3,;n��;'�.�`,.1is' i� ♦ !i�� ,,2 t ,� ='. ,- ��'�.�., X�e.'eL(rs.•�aux.:.-:: :•e _.^.ra:urt P::3 ."�.�'i ....uea.., an$�a t2'u aa..c»a' :..r_'.?'_'�.eliran:�a..:t. .'t�it :se�:ix• .`Sa.-u.h51`'_v! f� �a':!�- i.5� :. 8i5x ,r i�u.sw-- r^4,'.•F- s:. :�`viaz?Q'r':Mi":n ^.r•�i...is•`,d.,eR- ,.u• -.po.f;:^::u�i rw at'h.c:S.:.Rit?�o-::a:'aze'� a°C',':c�diKf�il4u�FP�!^�n. ._T.`^".. '"uT-?ki.l��_ ��r.•.:. : �-^o.: ,rw;. �,� �; .."• a; •b,l� 10 y lt, �� 12?1 .!!f �k►tS_° r# .. �4 -� 4 �r�,...__a �., 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 31.7-964-2364. Public Safety Medical - INVOICE Fo- Public Safety Medical Invoice Date: 10/25/20181 +. 6612 E.75th Street Invoice# 00-33908 -E Floor 2 W Indianapolis,IN 46250 Terms: o Carmel Fire Department 1 CARMEFD 12 Denise Snyder, Budget&Accred Mgr m Dsnyder@carmel.In.Gov(B) Exclusively Serving Public Safety Professionals Since 1990. Date Employee Description Amount Balance Due 10/16118 Haboush David G. Commehensive Physical Exam 117 Respirator/Medical Review $19.11 $19.11 OnMed Program $0.00 $0.00 Health RiskAppraisal Medikee er 0.00 $0.00 Med Opinion-Wellness $0.00 $0.00 Med Opinion-Respirator $0.00 $0.00 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 Signs-HT WT BP P R $0.00 $0.00 Viso -Acuity 31.06 $31.06 Pulmonary Function es 39.4 9 2 Audinmetry $16.73 $16.73 EKG.W/Interp $23.89 $23.89 Urinalysis-Dipstick $3.60 $3.60 10/17/18 Paddock Ronald"Dean" CMP(Comp Metabolic Panel 22.86 $22.86 CBC(Comp Blood Count 20.70 $20.70 Lipid Panel Blood 24.30 $24.30 Venipuncture $3.60 $3.60 PSA-Prostate Specific ABlood 1.8141.81 10/19/18 Frenzel Eric PFT-PulmonaryFunction Test 39.42 39.42 .Vital Signs-HT BP P R $0.00 0.00 Total Charges-> $602.99 Total Payments&Balance Due-> $0.001 $602.99 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.