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Home My WebLink About182057 02/03/2010 7 VENDOR: 00350364 CITY OF CARMEL INDIANA Page 1 of ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES 7../ CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $2,165.50 w row INDIANAPOLIS IN 46204 CHECK NUMBER: 182057 CHECK DATE: 2/3/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 12355 291.72 MEDICAL EXAM FEES 1115 4350900 12392 91.00 OTHER CONT SERVICES 1110 4340701 12393 1,782.78 MEDICAL EXAM FEES ii- .1: v R INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 ct Indianapolis, IN 46204 Carmel Clay Communications CARMCOM I 31 First Avenue NW Terms Carmel, IN 46032 Invoice Date 01/26/2010 m invoice 00 -12392 Date Employee Description Amount Balance Due 01/20/10 Southerland, Nicholas R Audiometry $15.00 $15.00 Speech Discrimination $50.00 $50.00 Vision Titmus $26.00. $26.00 Total Charges $91.00 Total Payments Balance Due $0.00 $91.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Ste 300 Indianapolis, In 46204 $91.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Clay Communications PO# Dept. INVOICE NO. ACCT #fTITLE AMOUNT Board Members 1115 00 -12392 43- 509.00 $91.00 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 Friday, January 29, 2010 Director 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)) 01/26/10 00 -12392 I 1 $91.00 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 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 0 Indianapolis, IN 46204 Carmel Police Department CARMEPD 1 C 3 Civic Square Terms Carmel, IN 46032 Invoice Date 01/20/2010 CO Invoice 00 12355 Date Employee Description Amount Balance Due 01/12/10 Dawson. Gregory F. CMP $15.30 $15.30 CBC W /Dill And Plat $12.24 $12.24 Lipid Panel $15.30 $15.30 Venipuncture Fee $3.06 $3.06, HIV 1 2 $13.26 $13.26 PSA $35.70 $35.70 Quantiferon Tb Gold $51.00 $51.00 01/13/10 Snow, Donald C. CMP $15.30 $15.30 CBC WIDiff And Plat $12.24 $12.24 Lipid Panel $15.30 $15.30 Venipuncture Fee $3.06 $3.06 HIV 1 2 $13.26 $13.26 PSA $35.70 $35.70 Quantiferon Tb Gold $51.00 $51.00 Total Charges $291.72 Total Payments Balance Due $0.00 $291.72 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date INVOICE 0 Public Safety Medical Services t 324 E. New York Street E Suite 300 re Indianapolis, IN 46204 C Carmel Police Department CARMEPD I 3 Civic Square Terms Carmel, IN 46032 Invoice Date 01/2612010 m Invoice 00 -12393 Date Employee Description Amount Balance Due 01/18/10 Hobson, Phillip L. CMP $15.30 $15.30 CBC W /Dill And Plat $12.24 $12.24 Lipid Panel $15.30 $15.30 Venipuncture Fee $3.06 $3.06 HIV 1 2 $13.26 $13.26 Quantiferon Tb Gold $51.00 $51.00 Troyer. Darin M. CMP $15.30 $15.30 CBC W /DiffAnd Plat $12.24 $12.24 Lipid Panel $15.30 $15.30 Venipuncture Fee $3.06 $3.06 HIV 1 2 $13.26 $13.26 Quantiferon Tb Gold $51.00 $51.00 White II, Robert E. CMP $15.30 $15.30 CBC W /Diff And Plat $12.24 $12.24 Lipid Panel $15.30 $15.30 Venipuncture Fee $3.06 $3.06 HIV 1 2 $13.26 $13.26 Quantiferon Tb Gold $51.00 $51.00 01/19/10 Dawson, Gregory F. Comprehensive Physical $92.82 $92.82 OnMed Program $0.00 $0.00 Respirator /Medical Review $16.32 $16.32 Health Risk Appraisal (Motivation) $16.32 $16.32 BIA (Bio -Elec Imped AnalyJ $14.28 $14.28 Treadmill (PFE) $156.00 $156.00 Waist/Hip Ratio $3.06 $3.06 Tonometry $36.72 $36.72 Vital Signs HT WT BP P R $7.14 $7.14 Vision Titmus $26.52 $26.52 PFT W /interp $33.66 $33.66 Audiometry $14.28 $14.28 ECG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Fisher, Charles B. CMP $15.30 $15.30 CBC W /Diff And Plat $12.24 $12.24 Lipid Panel $15.30 $15.30 Venipuncture Fee $3.06 $3.06 HIV 1 2 $13.26 $13.26 Quantiferon Tb Gold $51.00 $51.00 Snow, Donald C. Comprehensive Physical $92.82 $92.82 Health Risk Appraisal (Motivation) $16.32 $16.32 OnMed Program $0.00 $0.00 Respirator /Medical Review $16.32 $16.32 BIA (Bio -Elec Imped Analy) $14.28 $14.28 Flexibility Check $10.20 $10.20 Waist /Hip Ratio $3.06 $3.06 Treadmill (PFE) $156.00 $156.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 a Indianapolis, IN 46204 r o Carmel Police De CARMEPD I 3 Civic Square Terms Carmel, IN 46032 Invoice Date 01/26!2010 m Invoice 00 -12393 Date Employee Description I Amount I Balance Due I Tonometry $36.72 $36.72 Vital Signs HT WT BP P R $7.14 $7.14 Vision Titmus $26.52 $26.52 PFT W /Intero $33.66 $33.66 Audiometry $14.28 $14.28 ECG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Stites, William R. Comprehensive Physical $92.82 $92.82 Health Risk Appraisal (Motivation) $16.32 $16.32 OnMed Program $0.00 $0.00 Respirator /Medical Review $16.32 $16.32 BIA (Bio -Elec Imped Analy) $14.28 $14.28 Flexibility Check $10.20 $10.20 Waist/Hip Ratio $3.06 $3.06 Treadmill (PFE} $156.00 $156.00 Tonometry $36.72 $36.72 Vital Signs HT WT BP P R $7.14 $7.14 Vision Titmus $26.52 $26.52 PFT W /Interp $33.66 $33.66 Audiometry $14.28 $14.28 ECG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Total Charges $1,782.78 Total Payments Balance Due $0.00 $1,782.78 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 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)) 1/20/10 12355 payment for officer physicals 291.72 1/26/10 12393 payment for officer physicals 1,782.78 1/26/10 12395 payment for officer Total 2,074.50 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 2,074.50 ON ACCOUNT OF APPROPRIATION FOR police general ufnd Board Members PO# or DEPT. I NVOICE NO. ACCT #/TITLE AMOUNT 1 hereby certify that the attached invoice(s), or 1110 12355 407 -01 291.72 bill(s) is (are) true and correct and that the 1110 12393 407 -01 1,782.78 materials or services itemized thereon for which charge is made were ordered and received except January 28 20 10 *7 e A Signature Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund