182974 03/03/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
's CHECK AMOUNT: $8,156.34
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
�'7ax G INDIANAPOLIS IN 46204 CHECK NUMBER: 182974
CHECK DATE: 3/3/2010
DEPARTMENT ACCO PO NUMBER INVOICE NUMBER AMOUNT DESCR
1110 4340701 12209 4.44.00 MEDICAL EXAM FEES
1110 4340701 12459 3,906.18 MEDICAL EXAM FEES
1110 4340701 12520 3,806.16 MEDICAL EXAM FEES
INVOICE
oo Public Safety Medical Services
324 E. New York Street
E Suite 300
tY Indianapolis, IN 46204
C Carmel Police Department I CARMEPD
Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 02/12/2010
m Invoice 00 -12459
Date Employee Description Amount Balance Due
Audiornetry $14.28 $14.28
ECG W1 Inter 20.40 20.40
Urinalysis Dipstick $3.06 3.06
Total Charges 1 $3,906.18
Total Payments Balance Due $0.00 1 $3,906.18
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
FEB -1 -20 10 TUE 11;29 AM Public Safety Medical FAX N0, 93273108 P. 01/01
INVOICE
F
Public Safety Medical Services
324 E, New York Street
E Suite 300
a' Indianapolis, IN 46204
Carmel Police Department 1 CARMEPD Torras
3 Civic Square Invoice Date 1211512009
Carmel, IN 46032 invoice 00.12209
Date Em lovee Description Amount Balance Due
12J07109 Glibert Willlgm J. CMP $16.00 16.0
CE3C WIDIff And PIn $13.00 13,0
t. A Panel 16.80 16.0
Venl uncture Fee 3,00 3.00
HIV 1 2 3.DO 13,00
aniNeron b Gold 5D.p 50.00
K eith. Brett A, CMP 6.00 16.0
r C W/Diff d P 9 0 3.D
Li a el 536.00 n
Vaninuncturn Fee n0 m0
HI I
HIV 1 iferon Th Gold $50.00 50,00
Zellers Nancy I_, CMP 1E.00 .16.00
cBC WIDiff And Plat 13,00 $13.00
Lipid Panel $16.00 16.0
Venl uncture pee 13.00 $3.00
HIV 11A 2 $13.00 $13.0 0
uantlferoi rb Gold 50.00 $5Q10
p2 rics n C 6.00 16 0
CSC And Pla S1 3.00 3.00
o u nn
rl a 3.n0 .3 0
n
Quanllforon 7b Go] d $50.00 50.00
Total Charges $�Igh.00
Total Payments Balance Due $0.00 $444,00
Please write invoice number on payment check.
Our Federal Employer Identificatlon Number Is 35- 2079797
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
ix Indianapolis, IN 46204
G Carmel Police Department l CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 0211212010
ED Invoice 00 -12459
Date Employee Description Amount Balance Due
02/01110 Collins, Shane P. CMP $15.30 $15.30
CBC WIDiff And Plat $12.24 $12.24
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
Flamin Anna G. Hepatitis B Vaccination #3 $71.40. $71.40
In ection Fee $10.20 $10.2 0
Goodman Leland C. CMP $15.30 $15.3 0
CBC WIDiff 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
Sedberry Jeffrey T. CMP 15.30 $115.30
CBC W /Dill And Plat $1224 $12.24
Lipid 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
Towle John R. CMP $15,30 $15.30
CBC WIDiff And Plat $12,24 $12.24
Libid S15. $15.3 0
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
PSA $35,70 $35.70
Wie man. Chad R. CMP $15.30 $15.3 0
CBC WIDiff And Plat $12,24 $12.24
Li id Panel $15.30 $15.3C
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.0 0
Williams. Ashley L. CMP $15.30 S15.3 0
CBC WIDiff And Plat $12.24 $12.241
Li id Panel $15.30 $15.30
Veni uncture Fee $3.06 $3.06
Quantiferon Tb Gold $51.00 $51.00
02 /03 /10 Hill, Nathaniel W. Comprehensive Physical $92.82 $92.82
Health Risk Appraisal Motivation $16.32 $16.32
OnMed Program $0.00 $0.00
Respirator/Medical Review 116.32 $16.32
BIA Bio -Elec Im ed Anal 14.28 $14.28
Flexibility Check $10.20 $10.20
Waist/Hi 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
X Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN-46032 Invoice Date 02/12/2010
m Invoice 00 -12459
Date Employee Description Amount Balance Due
Tonometry $36.72 $36.72
Vital Si ns HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 2652
PFT W/Interp $33.66 3
Audiometry $14.28 $14.28
ECG W/ Irtterp $20.40 $20.40
Urinalysis Dipstick $3.06 $3.06
Hobson Philli2 L. Comprehensive Physical $92.82 $92.82
OnMed Program $0.00 $0.0 0
Respirator/Medical Review 16.32 $16.32
Health Risk Appraisal Motivation 16.32 $16.32
BIA Bio -Eiec Im ed Anal 14.28 $14.28
Flexibility Check $10.20 $10.20
Waist/Hi Ratio $3.06 $3.06
Treadmill (PFE) $156.00 $156.0D
Tonometry $36.72 $36.72
Vital Signs HT WT BP P R $7.14 $714
Vision Titmus $26.52 $26.52
PFT W/Interp $33.66 $33.66
Audiomet $14.28 $14.28
ECG W/ Interp $20.40 $20.4 0
Urinalysis Dipstick $3,06 3.06
Loyeall. Gregory A. 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 Bin -Eiec Im ed Anal 14.28 $14.28
Flexibility Check $10.20 $10.2 0
Waist/Hi 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 $33.661
Audiomet 14.28 14.28
ECG W/ Interp $2D.40 $20.4 0
Urinalysis Di stick $3.05 $3.06
Moore. Scott L. Comprehensive Physical $92.82 $92.82
Health Risk Appraisal Motivation 16.32 $16.32
OnM d Program $0,00 so,00l
Respirator/Medical Review $16.32 $16.32
BIA (Bic-Eiec Im ed Anal $14.28 $14.28
Flexibility Check $10.20 $10.20
Waist/Hi 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 1 $7.14
INVOICE
I o Public Safety Medical Services
324 E. New York Street
E Suite 300
tx Indianapolis, IN 46204
G Carmel Police Department 1 CAR,MEPD
3 Civic Square Terms
W Carmel, IN 46032 Invoice Date 02/12/2010
m Invoice 00.12459
Date Employee Description Amount Balance Due
Vision Titmus $26.52 $26.52
PFT W/Interp $33.66 $33.66
Audiometry 14.28 $14.28
ECG WI Interp $20.40 20.40
Urinalysis Dipstick $3.06 $3.06
Tilson. Travis C. Comprehensive Physical 192.82 $92.82
Health Risk Appraisal Motivation 16.32 $16.32
OnMed Program $0.00 $0.00
Respirator/Medical Review $16.32 $16.32
Flexibilit Check $10.20 $10.20
YV i 5 U Hi Ratio $3,06 $3.0
Treadmill (PFE $156.00 $156.00
TonornetrV $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 S3.06
White If Robert E. Comprehensive Physical $92.82 $92.82
Health Risk A raisal Motivation 16.32 $16.32
OnMed Pro ram 0.00 $0.00
Res irator /Medic f Review $16. $16.32
BIA Bio -Elec Im ed Anal $14.28 $14.28
Flexibility Check $10.20 $10.20
Waist/Hi Ratio $3.06 3.06
Treadmill PFE 156.00 $156.00
Tonomet 36,72 $36,72
Vital Signs HT WT BP P R $7.14 $7,14
Vision Titmus $26.52 $26.52
PFT W /Inter 33.66 $33.66
Audiornetry $14.28 $14.28
ECG W1 Interp $20.40 $20.40
Urinalysis Dipstick $3, 0 106
William Mliams, Ashley L. Comprehensive Physical $92.82 $92.8
OnMed Program $0.00 $0.00
Respirator/Medical Review $16.32 $16.32
Health Risk Appraisal Motivation $16.32 $16.32
BIA Bio -Elec Im ed Anal $14.28 $14.28
Flexibility Check 10.20 $10.2 0
Waist/Hi Ratio $3.06 3.06
Treadmill PFE 156.00 $156.00
Tonornetry $36.72 $36,72
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus 26,52 $26.52
PFT W /Inter 33.66 $33.66
INVOICE
�o Public Safety Medical Services
324 E. New York Street
E Suite 300
01
[t tndianapolis, IN 46204
G Carmel Police Department CARMEPD
F 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 02/12/2010
Invoice 00 -12459
Date Employee Description Amount Balance Due
Audiometry 14.28 $14.28
ECG W/ Interg $20.40 20.40
Urinalysis Di stick 3.06 3.06
Total Charges $3,906.18
Total Payments Balance Due I $O.00l $3,906..18.
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Pres[k by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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 invoices) or bill(s))
12/15/09 12209 pavment for officer physicals 444.00
2/12/10 12459 payment for officer physicals 06.18
Total 4,350-18
1 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
VOJCHER NO. WARRANT NO.
ALLOWED 20
Tblic Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
4,350.18
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
Po# or INVOICE NO. ACCT #(TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 12209 407 -01 444.00 bill(s) is (are) true and correct and that the
1110 12459 407 -01 3,906.18 materials or services itemized thereon for
which charge is made were ordered and
received except
February 25 20 10
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
`w
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
a)
X Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPD
Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 0212412010
Invoice 00 -12520
Date Employee Description Amount Balance Due
02/15/10 Barlow, James C. CMP $15.30 $15.30
CBC W /Dill And Plat $12.24 12.24
Lipid Panel 515.30 $15.30
Veni uncture Fee 3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantlferon Tb Gold $51.00 51.00
PSA $35.70 $35.70
Driver. Charles E. CMP $15,30 "15.30
CBC W /DIff And Plat $12,24 $12.24
Lipid Panel 15.30 $15.3 0
Veni uncture Fee $3.06 $3.06
Quantiferon Tb Gold $51.00 $51.00
02/16/10 Barlow, James C. Comprehensive Physical $92.82 $92.82
Health Risk Appraisal Motivation $1632 $16.32
OnMed Program $0.00 $0.00
Respirator/Medical Review $16.32 $16.32
BIA Bio -Elec Im ed Anal 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 $26J2
PFT W/Interp $33.66 $33.65
Audiometry $14.28 $14.28
ECG W/ Interp $20.40 $20.4 0
Urinalysis Dipstick $3.06 $3.06
Collins. Shane P. Comprehensive Physical $92,82 $92.82
Health Risk A raisai Motivation 1632 16.32
OnMed Program 0.00 0.00
Respirator/Medical Review 16.32 16.32
BIA Bio -Elec Im ed Anal 14.28 14.28
Rexibilit Check 10.20 $10.2 0
Waist/Hip Ratio $3.06 $3,0
Treadmill PFE 156.00 156.00
Tonornetry $36.72 $36.72
Vital Signs HT WT BP P R $7.14 $7.14
Vision T t nus $26.52 $26.52
PFT W/Interp $33.66 $33.66
Audiometry 14.28 $14.28
ECG W/ Interp $20.40 $20.4 0
Urina( sis Dipstick 3.06 $3,06
Driver Charles E. Comprehensive Physical $92,82 $92.82
Health Risk Appraisal Motivation 16.32 $16.32
OnMed Pro ram JO.00 $0.00
Res irator /Medical Review $16.32 $16.32
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
0
X Indianapolis, IN 46204
C Carmel Police Department CARMEPD
F 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 0212412010
m Invoice 00 -12520
Date Employee Description Amount Balance Due
Flexibility Check $10.20 $16.20
Waist/Hip Ratio 1106 $3.061
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
Goodman Leland C. Comprehensive Physical $92.82 $92,82
Health Risk Appraisal Motivation 16.32 $16.32
Respirator/Medical Review $16.32 $16.32
OnMed Program $0.00 $0.00
BIA Bio -Elec Im ed Anal 14.28 $14.28
Flexibility Check $10.20 $10.20
Waist/Hi Ratio $3.06 $3.06
Treadmill (PFE) $156.00 $156.00
Tonomet $3672 $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
AudiometEy $14.28 $14.281
ECG W/ Interp $20.40 $20.40
Urinalysis Dipstick $3,06 $3.06
Sedberry, Jeffrey T. Comprehensive Physical $92.82 $92.82
Health Risk Appraisal Motivation 16.32 $16.32
OnMed Program $0.00 S0.00
Respirator/Medical Review $16.32 i $16.32
Flexibility Check $10.20 $10.20
Waist/Hi Ratio $3.06 $3.06
Treadmill (PFE $156.00 $156.00
Tonoinetry $36.72 $36.72
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus 2652 $26.52
PFT W/Interp $33.66 $33.66
Audiometry $14.28 $14.28
ECG W/ Intern $20.40 $20.4 0
Urinalysis Di tick .06 $3.06
Towle, John R. Comiprehe nsiv Physical S92. $92,82
Health Risk Appraisal Motivation $16.32 $15.32
OnMed Program $0.00 $0.00
Respirator/Medical Review $16.32 $16.32
BIA Bio -Elec Im ed Anal $14.28 $14,28
Flexibilit Check $10.20 $10.20,
Waist /Hi Ratio $3.06 $3.06
Treadmill PFE 156.00 $156.00
INVOICE
H Public Safety Medical Services
w 324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
G Carmel Police Department I CARMEPD
l 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 02124/2010
m Invoice 00 -12520
Date Employee Description Amount Balance Due
Tonometry $36.72 $3672
Vital Signs HT WT BP P R $7,14 7.14
Vision Titmus $26.52 $26.52
PFT Wllnterp $33.66 $33.66
Audiometry $14.28 $14.281
ECG W1 Interp $20.40 120AQ
Urinalysis Dipstick $3.06 $3.06
Troyer Darin M. Comprehensive Physical $92.82 $92.82
Health Risk Appraisal Motivation 16.32 $16.32
OnMed Pro ram $0.00 $0.00
Resoirator/Medicad Review $16.32 $16.32
BIA Bio -Elec Im ed Anal $14.28 $14.28
Flexibility Check $10.20 $10.20
WaisUHi 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 $7,141
Vision Titmus 26,52 $26.52
PFT W/Interp $33.66 $33.66
Audiometry 14.28 $14,28
ECG W1 Interr $20.40 $20.40
Urinalysis Dipstick $3.06 3.06
Wie man Chad R. Com rehensive Physical $92.82 S92.82
Health Risk Appraisal Motivation $16.32 $16.32
OnMed Program $0.00 $0.00
Respirator/Medical Review $16.32 $16,32
Flexibility Check $10.20 $10.2 0
Waist/Hi Ratio 3.06 $3.061
Treadmill (PPE $15600 $156.0 D
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 14.8 14.28
ECG Wl Interp 12D.40 $20.40
Urinalysis Dipstick $3.06 $3.D6
Total Charges $3,806.16
Total Payments Balance Due $0.00 $3,806.16
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
i. Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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))
2/24/10 12520 payment for officer physicals
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
TOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
3,806.16
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
6 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 26 20 10
A 'dipmP I
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund