183430 03/16/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $1,072.84
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 183430
CHECK DATE: 311612010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340702 12519 160.00 SHO'T'S INOCULATIONS
1110 4340701 12548 436.50 MEDICAL EXAM FEES
1110 4340701 12586 476.34 MEDICAL EXAM FEES
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Fire Department 1 CARMEFD
t 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 02/24/2010
m Invoice 00 -12519
Date Employee Description Amount Balance Due
02/15/10 Grimes. Jeffrey A. Hepatitis B Vaccination #3 $70.00 $70.00
Inmection Fee 10.00 $10.0 0
02116110 Platt Jace P. Hepatitis B Vaccination #3 70.00 $70.0 0
Inmection Fee 10.00 10.00
Total Charges $160.00
Total Payments S Balance Due .50.00 $160.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
h
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$1 60.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1120 12519 43- 407.02 $160.00 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
MAR 1.
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
t
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))
12519 $160.00
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
L INVOICE
H Public Safety Medical Services
1 324 E. New York Street
E Suite 300
Indianapolis, IN 46204
G Carmel Police Department! CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 03/09/2010
Invoice 00 -12586
Date Employee Description Amount Balance Due
03/01/10 Bodenhorn, Wendy M. CMP $15.30 $15.30
CBC W /Dill 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
Henrv, David R. CMP $15.30 $15.3 0
CBC W /Dill And Plat $12.24 $12.24
Lipid Panel $15.30 $15.3 0
Veni uncture Fee $3.06 $3,06
HIV $13.26 1
Quantiferon Tb Gold $51.00 $51.00
Strong. David C. CMP $15.30 $15.30
CBC W1Diff 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
PSA $35.70 $35.70
uantiferon Tb Gold $51.00 51.00
03/03/10 Miller Michael G. CMP $15.30 $15.30
CBC W /Dill And Plat $12.24 $12.24
Li id Panel $15.30 15.30
Veni un ture Fee $3,06 3.0
HIV 1 &2 $13.26 $13.26
Quantiferon Tb Gold $51.00 51.00
Total. Charges $476.34
Total Payments Balance Due $0.00 $476.34
Please write invoice number on payment check.
Balance Due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 date
U INVOICE
t o Public Safety Medical Services
1 324 E. New York Street
E Suite 300
w Indianapolis, IN 46204
O Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 03/03/2010
Invoice 00 -12548
Date Employee Description Amount Balance Due
02/25/10 Laker Jeffre W. Comprehensive Physical $92.82 $92.82
OnMed Program $00() 0.00
Res irator /Medical Review $16.32 $16.32
Health Risk Appraisal Motivation 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 Signs HT WT BP P R $7.14 $7.1 4
Vision Titmus 26.52 $26.52
PFT W/Intery $33.66 33.6
Audiomet $14.28 $14.28
ECG W/ Interp $20.40 $20.40
Urinalysis Di stick $3,06
Total Charges $436.50
Total Payments Balance Due $0.00 $436.50
Please write invoice number on payment check.
Our Federal Employer identification Number is 35- 2079797
Balance due 15 days from invoice
date
Pres§4ribed 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))
3/3/10 12548 payment for officer physical 436.50
3/9/10 12586 nnvmpnt for officer physicals 476-14
Total 912.84
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
VOWCHER NO. WARRANT NO.
t
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
police generallfund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 12548 407 -01 436.50 bill(s) is (are) true and correct and that the
1110 12586 407 -01 476.34 materials or services itemized thereon for
which charge is made were ordered and
received except
March 11 20 10
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund