181637 01/20/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
•h I CHECK AMOUNT: $4,897.90
CARMEL, INDIANA 46032 324E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 181637
l z°n G
CHECK DATE: 1/20/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 12286 2,310.00 MEDICAL EXAM FEES
1110 4340701 12287 2,491.00 MEDICAL EXAM FEES
1110 4340701 12319 96.90 MEDICAL EXAM FEES
INVOICE
J- o Public Safety Medical Services
w 324 E. New York Street
E Suite 300
ce Indianapolis, IN 46204
e Carmel Police Department CARMEPD
H 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 01/07/2010
to Invoice 00.12287
Date Employee Description Amount Balance Due
12/29/09 Bickel, Joseph E. Comprehensive Physical $91.00 $91.00
Health Risk Appraisal (Motivation) $16.00 $16.00
OnMed Program $0.00 $0.00
Respirator /Medical Review $16.00 $16.00
BIA (Bio -Elec Imped Analv) $14.00 $14.00
Flexibility Check $10.00 $10.00
Waist/Hip Ratio $3.00 $3.00
Muscle Strength Endurance $26.00 $26.00
Treadmill (PFE) $153.00 $153.00
Vital Signs HT WT BP P R $7.00 $7.00
Vision Titmus $26.00 $26.00
PFT W /Interp $33.00 $33.00
Audiometry $14.00 $14.00
ECG W/ Interp $20.00 $20.00
Urinalysis Dipstick $3.00 $3.00
Howard, Lana M. Comprehensive Physical $91.00 $91.00
Health Risk Appraisal (Motivation) $16.00 $16.00
OnMed Program $0.00 $0.00
Respirator /Medical Review $16.00 $16.00
BIA (Bio -Elec Imped Analv) $14.00 $14.00
Flexibility Check $10.00 $10.00
Waist/Hip Ratio $3.00 $3.00
Muscle Strength Endurance $26.00 $26.00
Treadmill (PFE) $153.00 $153.00
Vital Signs HT WT BP P R $7.00 $7.00
Vision Titmus $26.00 $26.00
PFT W /Interp $33.00 $33.00
Audiometry $14.00 $14.00
ECG W/ lnterp $20.00 $20.00
Urinalysis Dipstick $3.00 $3.00
Miller, Adam C. Comprehensive Physical $91.00 $91.00
Health Risk Appraisal (Motivation) $16.00 $16.00
OnMed Program $0.00 $0.00
Respirator /Medical Review $16.00 $16.00
,BIA (Bio-Elec lmped Analv) $14.00 $14.00
Flexibility Check $10.00 $10.00
WaisUHip Ratio $3.00 $3.00
Muscle Strength Endurance $26.00 $26.00
Treadmill (PFE) $153.00 $153.00
Vital Signs HT WT BP P R $7.00 $7.00
Vision Titmus $26.00 $26.00
PFT W /Interp $33.00 $33.00
Audiometry $14.00 $14.00
ECG W/ Intern $20.00 $20.00
Urinalysis Dipstick $3.00 $3.00
Pirics, John D. Comprehensive Physical $91.00 $91.00
l l
INVOICE
1
F oo Public Safety Medical Services
324 E. New York Street
E Suite 300
m
ix Indianapolis, IN 46204
o Carmel Police Departme 1 CARMEPD
I 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 01/0712010
03 Invoice 00 -12287
Date 1 Employee I Description 1 Amount I Balance Due
OnMed Program $0.00 $0.00
Health Risk Appraisal Motivation) $16.00 $16.00
Respirator /Medical Review $16.00 $16.00
Flexibility Check $10,00 $10.00
Waist/Hip Ratio $3.00 $3.00
Treadmill (PFE) $153.00 $153.00
Vital Signs HT WT BP P R $7.00 $7.00
Vision Titmus $26.00 $26.00
PFT W /Interp $33.00 $33.00
Audiometry $14.00 $14,00
ECG W/ Interp $20.00 $20.00
Urinalysis Dipstick $3.00 $3.00
I Schalburq, Randy S. Comprehensive Physical $91.00 $91.00
Health Risk AppraisalkMotivation) $16.00 $16.00
OnMed Program $0.00 $0.00
_Respirator /Medical Review $16.00 $1600
BIA (Bio -Elec Imped Analy) $14.00 $14.00
Flexibility Check $10.00 $10.00
Waist /Hip Ratio $3.00 $3.00
Treadmill (PFE) $153.00 $153.00
Hemoccult $5.00 $5.00
Vital Signs HT WT BP P R $7.00 $7.00
Vision Titmus $26.00 $26.00
PFT W /Intep $33.00 $33,00
Audiometry $14.00 $14.00
ECG W/ Interp $20.00 $20.00
Urinalysis Dipstick $3.00 $3.00
,Zellers. Timothy V. Comprehensive Physical $91.00 $91.00
Health Risk Appraisal (Motivation) $16.00 $16.00
OnMed Program $0.00 $0.00
Respirator /Medical Review $16.00 $16.00
Flexibility Check $10.00 $10.00
Treadmill (PFE) $153.00 $153.00
Waist/Hip Ratio $3.00 $3.00
Vital Signs HT WT BP P R $7,00 $7.00
Vision Titmus $26.00 $26.00
PFT W /Interp $33.00 $33.00
Audiometry $14.00 $14.00
ECG W/ Interp $20.00 $20.0Q
Urinalysis Dipstick $3.00 33.00
Total Charges $2,491.00
Total Payments Balance Due 30,00 $2,491.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
Payee
Public Safety Medical Services Purchase Order No.
324 E. New York Street, Suite 300 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/7/10 12287 payment for officer physicals 2,491.00
Total
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
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
2.491.00
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
Po# INVOICE NO ACC AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 12287 407 01 2,491 .000 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
January 13 20 10
b
Signature
Chief of POlice
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
x Indianapolis, IN 46204
Carmel Police Department CARMEPD
Terms
3 Civic Square Invoice Date 01/13/2010
Carmel, IN 46032 Invoice 00 -12319
Date Employee Description Amount Balance Due
01/04/10 Hill, Nathaniel W CMP $15.30 $15.30
CBC WfDiff And Plat $12.24 $12.24
Lipid Panel $15.30 $15.30
Venipuncture Fee $3.06 $3.06
Quantiferon Tb Gold $51.00 $51.00
Total Charges $96.90
Total Payments Balance Due $0.00 $96.90
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
Prescribed by State Board of Accounts City Form No. 20f (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
Payee
Public Safety Medical Services Purchase Order No.
'324 E. New York Street, Suite 300 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/13/10 12319 monthly payment 96.90
Total
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
Clerk- Treasurer
VOUQHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services IN SUM OF
324 E. New York Street, suite 300
Indianapolis, IN 46204
96.90
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
SOT r INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
1110 12319 407 -01 96.90 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
January 14 20 10
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
INVOICE
i- 0 Public Safety Medical Services
324 E. New York Street
E Suite 300
m
tY Indianapolis, IN 46204
o Carmel Fire Department CARMEFD
F" 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 01/07/2010
m Invoice 00 -12286
,Date Employee Description Amount Balance Due
12/29/09 Alverson, Jonathon L. Funct Move Screen $70.00 $70.00
Contino, David M. Funct Move Screen $70.00 $70.00
Drake, Carl D. Funct Move Screen $70.00 $70.00
Fuchs, Jeffery W. Funct Move Screen $70.00 $70.00
Gehlbach, Marc A. Funct Move Screen $70.00 $70.00
Holubik, Steven VV. Funct Move Screen $70.00 $70.00
Horner, David W. Funct Move Screen $70.00 $70.00
Keaton, Anthony R. Funct Move Screen $70.00 $70.00
Kinney, Jared N. Funct Move Screen $70.00 $70.00
Marsh, Michael A. Funct Move Screen $70.00 $70.00
Price. Joseph P. Funct Move Screen $70.00 $70,00
Stindle, Kevin P. Funct Move Screen $70.00 $70.00
Stroup, Scott A, Funct Move Screen $70.00 $70.00
Utzig, Todd T. Funct Move Screen $70.00 $70.00
Voskuhl, Mark J. Funct Move Screen $70.00 $70.00
Zeller, Michael J. Funct Move Screen $70.00 $70,00
12/30/09 Bailey, Mark E. Funct Move Screen $70.00 $70.00
Baskerville, Steven P. Funct Move Screen $70.00 $70.00
Brant, Kenneth E. Funct Move Screen $70.00 $70.00
Brisco, Michael D. Funct Move Screen $70.00 $70.00
Dufek, Gary J. Funct Move Screen $70.00 $70.00
Frost, Bruce S. Funct Move Screen $70.00 $70.00
Guoel. Mark E. Funct Move Screen $70,00 $70.00
Hutchison, Brian P. Funct Move Screen $70.00 $70.00
Marcum, Bradley D. Funct Move Screen $70.00 $70.00
Martin, Richard A. Funct Move Screen $70.00 $70.00
Mason, Bryan L. Funct Move Screen $70.00 $70.00
McNeely, Michael W. Funct Move Screen $70.00 $70.00
Mead, David I_ Funct Move Screen $70.00 $70.00
Peterson, Vernon A. ,Funct Move Screen $70.00 $70.00
Plumer. Charles J. Funct Move Screen $70.00 $70.00
Reynolds. Shawn J. Funct Move Screen $70.00 $70.00
Weaver, Virgil L. Funct Move Screen $70.00 $70.001
Total Charges $2,310.00
Total Payments Balance Due $0.00 $2,310.00
Please write invoice number on payment check.
Our Federal Employer Identification is 35- 2079797
Balance due 15 days from invoice
date
VOUCIIER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$2,310.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 12286 43- 407.01 $2,310.00 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
JAN 1'9 2010
-j (1647;
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12286 $2,310.00
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
Clerk- Treasurer