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184450 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,848.62 r•� CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 ti�.oe INDIANAPOLIS IN 46204 CHECK NUMBER: 184450 CHECK DATE: 4/14/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340702 12695 70.00 SHOTS INOCULATIONS 1110 4340701 12696 3,778.62 MEDICAL EXAM FEES INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46244 G Carmel Fire Department I CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 04101I2010 Invoice 00 -12695 Date Employee Description Amount Balance Due 03/24/10 Grimes Jeffrey A. HB SAb Quantitative Titer $35.00 $35.00 Platt Jace P. HB SAb Quantitative Titer $35.00 35.00 Total Charges $70.00 Total Payments Balance Due $0:00: $70.00 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 East New York Street, Ste. 300 Indianapolis, IN 46204 $70.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 12695 43- 407.02 $70.00 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 AP 12 2010 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)) 12695 $70.00 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 r E Suite 300 It Indianapolis, IN 46204 o Carmel Police Department CARMEPD F 3 Civic Square Terms Carmel, IN 46032 Invoice Date 04/01/2010 Invoice 00 -12696 Date Employee Description Amount Balance Due 03/24/10 Bodenhorn, Wendy M. 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 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/Interp $33.66 $33.66 Audiometry $14,28 $14.28 ECG W/ Interp $20.40 $20.40 Urinal sis Di stick $3.06 $3.06 Collins. Willie H. 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 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 Tonomet $36.72 $36.72 Vital Signs HT WT BP P R $7.14 $7.14 Vision Titmus 26.52 $26.52 PFT W/Interp 133.66 33.66 Audiometry 14.28 $14.28 ECG W/ Interp $20.40 $20.401 Urinalysis Di stick $3.06 $3.06 Hastv, Zachery R. Muscle StrencLth Endurance $26.52 $26,52 Com rehensive Physical $92.82 $92.82 Health Risk Appraisal Motivation 16.32 $16.32 OnMed Program Res irator Medi al Review $16.32 $16.32 BIA Bio -Elec Im ed Anal $14.28 $14.28 Flexibili Check $10.20 $10.20 Waist/Hi Ratio 3.06 $3.06 Treadmill (PFE) $156.00 $156.00 Tonometry $36.72 136.72 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 WI Int r 20.40 $20,40 Urinalysis Di stick $3.06 $3.06 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 G Carmel Police Department CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 04!0112010 m Invoice 00 -12696 Date Employee Description Amount Balance Due Henry David R. Comprehensive Physical $92.82 $92.82 Health Risk A raisal Motivation 16.32 16.32 OnMed Program $0.00 $0.00 R ira r M di al Review $16. $16,32 BIA Bic -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 Tonornetry $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 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Miller Michael G. Com rehensive 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 -El ec Im ed Anal $14.28 $14.28 Flexibility Check $10.20 1020 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 S26.52 $26.521 PFT W /Inter 33.66 $33,66 Audiomet $14,28 14.28 EGG W/ Interp $20.40 $20.40 Urina! sis Dipstick $3.06 $3.06 Robbins. Todd Comprehensive Ph sical $92.82 $92.82 Health Risk Appraisal Motivation 16.32 $16.32 OnMed Program $0. 00 $0.001 Respirator/Medical Review $16,32 $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 $156.0 0 Tonomet S36.72 $36.72 Vital Sin HT WT BP P R $7.14 $7.14 Vision Titmus $26.52 $26.52 PFT W /Inte $33.66 $33.66 Audiometry $14.28 $14.28 ECG W/ Inter 20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Strong David C. Comprehensive Physical $92.82 $92.82 OnMed Program so.00 0.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN are Invoice Date 04/01/2010 m Invoice 00 -12696 Date Employee Description Amount Balance Due Health Risk Appraisal Motivation $16.32 $16.32 Respirator/Medical Review $16.32 $16.32 BIA Bio -Elec Im ed Anal 14,28 14.28 Flexibility Check 110.20 10.20 Waist /Hi Ratio $3.06 $3.06 Treadmill (PFE) $156.00 $156.0 0 Tonomet 36.72 36.72 Vital Signs HT WT BP P R $7.14 $7.14 Vision Titmus $26.52 $26.52 PFT Wlinterjp S33.66 $33.66 Aud iometry 14 $14.2 ECG W/ Interp $20.40 $20.40 Urinal sis -Di stick $3.D6 $3.06 Theis Adam G. CMP $15.30 $15.30 CBC W /Dill And Plat $12.24 $12.241 Lipid Panel $15.30 $15.3 0 Veni uncture Fee $3.06 $3.06 HIV 1 2 $13.26 $13.26 uantiferon Tb Gold 51.D0 $51.0 0 HB SAb Quantitative Titer $35.70 $35.70 Com rehensive Physical $92.82 $92.82 OnMed Program SO.00 $0.00 Respirator/Medical Review JJ 2 $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 WaistlHip 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 nt 20.40 $20.4 Urinalysis Dbsfick 110 .0 Total Charges .$3,778:62 Total Payments Balance Due $0100 $3,778.62 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 Publi Safety M edical S ervices Purchase Order No. 324 E New York St #300 Terms Indpls, IN 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 4/1/10 12696 payment for officer physicals 3,778.62 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 324 E New York t IN SUM OF Suite 300 Indpls, IN 46204 3,778.62 ON ACCOUNT OF APPROPRIATION FOR po ge neral fund Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 12696 407 -01 3,778.62 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 April 4, 2010 Signatur Chief o Poli e Cost distribution ledger classification if Title claim paid motor vehicle highway fund