182512 02/17/2010 F CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
i. ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,782.84
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 182512
CHECK DATE: 2/17/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 12426 2,870.00 MEDICAL EXAM FEES
1110 4340701 12427 912.84 MEDICAL EXAM FEES
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
0)
it Indianapolis, IN 46204
C Carmel Fire Department/ CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 02/03/2010
Invoice 00 -12426
Date Employee Description Amount Balance Due
01/25/10 Buttler James N. Funct Move Screen $70.00 $70.00
Giles William G. Funct Move Screen $70.00 $70,0 0
Maroon Ernie R. Funct Move Screen $70,00 $70.0 0
Orange Douglas D. Funct Move Screen $70.00 $70,0 0
Starr Gregory A. Funct Move Screen $70.00 $70.00
Utzig, Chad M. Funct Move Screen $70.00 $70.0 0
Vallone Frank Funct Move Screen $70.00 570.00
Workman William J. Funct Move Screen $70.00 $70.00
Wynn Barbara M. Funct Move Screen $70.00 $70.00
Young, Alan R. Funct Move Screen $70.00 70.00
0 1/26/10 Bartr m Brad A. Funct Move Screen $70.00 $70.0 0
Brandt Gary D. Funct Move Screen $70.00 $70.00
Cummins, Frank C. Funct Move Screen $70.00 $70.00
Davis James M. Funct Move Screen $70.00 $70.00
Hulett Mark A. Funct Move Screen $70.00 $70.00
Kilburn Roger L Funct Move Screen $70.00 $70,0 0
Lenze Theodore A. Funct Move Screen $70.00 $70.0 0
Moriarty, John F. Funct Move Screen S 70.00
Sharp Adam C. Fund Move Screen $70.00 $70,00
Steu r Kent C. Fund Move Screen $70.00 $70.00
Weddin ton Kurt L. Funct Move Screen $70.00 $70,0 0
01/27/10 Butts Renee L. Fund Move Screen $70.00 $70.0 0
C allahan, Mark Fun t Move Screen 7 .00 $70.0 0
Ellison. Christopher M. Funct Move Screen $70.00 $70.00
Foster James P. Fund Move Screen $70.00 $70.00
Freer. Keith T. Fund Move Screen $70.OD $70.00
Griffin, Timothy M. Fund Move Screen $70.00 70.00
Hensley, Robert R Funct Move Screen $70.00 $70.00
Howard. Wendelf E. Fund Move Screen $70.00 $70.0 0
Johnson JerernV S. Fund Move Screen $70.00 $70.00
Kelsheimer, Troy W. Fund Move Screen $70.00 $70.00
Knott Bruce A. Fund Move Screen $70.00 $70.00
Miller. Scott G. Fund Move Screen $70.00 70.00
Re c r Jason L. Funct Move Screen $70.00 $70.00
Steele. effre A. Fund Move Screen $70.00 $70.0
Tierney Scott A. Fund Move Screen $70.00 $70.00
VanVoorst Robert J. Fund Move Screen $70.00 $70.00
Walker Christopher E. Fund Move Screen $70.00 $70.00
Webb. Gregory A. Funct Move Screen $70.00 $70.00
Wendzel. Jason D. Funct Move Screen $70.00 $70.00
Woodburn. Scott E. Fund Move Screen $70,00 $70.00
Total Charges $2,870.00
Total Payments Balance Due $0.00 $2,870.00
Please write invoice number on payment check.
Balance due 15 days from invoice
date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$2,870.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept- INVOICE NO, ACCT #frITLE AMOUNT Board Members
1120 12426 43- 407.01 $2,870.00 1 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
2010 FED 15
f
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))
12426 $2,870.00
1 hereby certify that the attached invoice(s), or bi11(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
1 20
Clerk- Treasurer
INVOICE
F a Public Safety Medical Services
r 324 E. New York Street
E Suite 300
ix Indianapolis, IN 46204
p Carmel Police Department! CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 02!0312010
m Invoice 00.12427
Date Employee Description Amount Balance Due
01/25110 Moore, Scott L. CMP $15.30 $15.30
CBC WlDiff And Plat $12.24 $12.24
Lipid Panel 15.30 $15.3 0
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51.130 $51.0 0
Tilson Travis C. CMP $15.30 $15.3 0
CBC W /Dill And Plat $12.24 $12.24
Lipid Panel $15.30 $15.30
Veniouncture Fee $3.06 6
HIV 1 2 $1326 $13.26
Quantiferon Tb Gold $51.00 $51.0 0
01/28/10 Laker Jeffre W. CMP $15.30 $15.30
CBC W /Dill And Plat $12.24 S12.24
Lipid Panel $15.30 $15.30
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.0 0
Loveall. Gregory A. CMP $15.30 $15. 30
CBC W /Dill And Plat $12.24 $12.24
Li id Panel $15.30 $15.3 0
Veni uncture Fee $3.06 $3,06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
01/29/10 Fisher Charles B. Comprehensive Physical $92.82 $92.82
Health Risk Appraisal Motivation 16.32 $16.32
OnMed Program $0.00 $0.00
Res iratorlMedical Review $16.32 $16.32
Flexibility Check $10.20 $10.20
Waist/Hi Ratio $3.06 $3.06
Treadmill (PFE $156.00 $156.00
Tonornetry $36.72 $36.72
Vital Sin HT WT BP P R $7.14 7,14
Vision Titm 26.2 $26.52
PFT W/Interp $33.66 $33.66
Audiometry $14.28 1 $14.28
ECG W/ Interp $20.40 $20.40
Urinal sis Dipstick $3.06 $3.06
Total Charges $912.84
Total Payments Balance Due $0.00 $912.84
Please write invoice number on payment check.
Balance due 1.5 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.
3 24 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))
2 12427 payment for officer physicals 912.84
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
P ublic Safety Medical Services IN SUM OF
324 E. new York Street, Suite 300
Indianapolis, IN 46204
912.84
ON ACCOUNT OF APPROPRIATION FOR
p olice general fund
Board Members
°T# INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
1110 12427 407 -01 912.84 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
February 10 20 10
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund