185924 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $1,734.76
a,�• +o CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 185924
CHECK DATE: 5126/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340702 12888 160.00 SHOTS INOCULATIONS
1110 4340701 12889 498.78 MEDICAL EXAM FEES
1110 4340701 12947 1,075.98 MEDICAL EXAM FEES
w
INVOICE
M Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
G Carmel Police Department! CARMEPD
Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 05/12/2010
Invoice 00 -12889
Date Employee Description Amount Balance Due
05/03/10 Harting, Charles V. CMP $15.30 $15.30
CBC W1Diff 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
HIV 1 2 1126 $13.26
Pelzer Robert S. CMP $15.30 $15.30
CBC WIDiff 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 $13.2
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.00
Thomas Richard E. 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 13.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
HB SAb Quantitative Titer $35.70 $35.70
05/04/10 Park Gre A. CMP $15.30 $15.3 0
CBC W /Dill And Plat $12.24 $12.24
Li id Panel $15.30 $15.3 0
Veni uncture Fee $3.06 $3.06
Quantiferon Tb Gold $51.00 1 $51.00
Total:Charges $498.78
Total Payments &Balance'Due 1 $0.00 1 $498.78:
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
Prescibed by Stale 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))
5/12/10 12889 payment for officer physicals 498.78
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.
2a
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
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
p° z r INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
1110 12889 407 -01 498.78 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
May 21 20 10
l
Signature
Assistant Chief of Poli
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
O Carmel Police Department l CARMEPD
F 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 05/19/2010
Invoice 00 -12947
Date Employee Description Amount Balance Due.
05/14/10 Park Greg A. Comprehensive Physical $92.82 $92.82
OnMed Program $0.00 $0,00
Health Risk Appraisal Motivation 16.32 $16.32
Respirator/Medical Review $16.32 $16.32
Treadmill (PFE) $156.00 $156.00
BIA Bio Elec Im ed Anal 14.28 14.28
Waist/Hi Ratio $3.06 13.06
Flexibility Check $10.20 $10.2 0
Vital Signs HT WT BP P R $7.14 7.14
Vision Titmus $26.52 26.52
Audiometry 14 $14.2
ECG W/ Interp $20.40 $20.40
Urinalysis Dipstick $3.06 $3,06
Pelzer Robert S. Comprehensive Ph sical $92.82 $92.82
OnMed Pro ram $0.00 $0.00
Respirator/Medical Review $16.32 $16.32
BIA Bio -Elec Im ed Anal $14.28 $14.28
Waist/Hi Ratio $3.06 106
Flexibility Check $10.20 $10.20
Vital Si ns HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
Audiometry 14.28 S14.28
ECG W/Jnterg $20.40 20.40
Urinai sis Dipstick $3.06 $3.06
Tonometry $36.72 $36.72
Thomas Richard E. Comprehensive Physical 92.82 $92.82
OnMed Program $0,00 $0.00
Health Risk Appraisal Motivation 16.32 $16.32
Respirator/Medical Review 16.32 $16.32
Treadmill (PFE) $156.00 156.00
BIA Bio -Elec Im ed Ana! $14.28 $14.28
Waist/Hi Ratio $3.06 3.06
Flexibility Check $10.20 10.20
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus $26. $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
Tonometry 1 $36.72 36.72
Total Charges '$1 ,075.98
Total Payments Balance Due $0.00 $1,075.98
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 date
Prescjibed 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 S ervices Purchase Order No.
324 E. New York Street, Suite 300 Terms
Indianapoli IN 46 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
5/19/10 12947 payment for officer physicals 1,075.98
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 IN SUM OF
324 E. New York Street, Suite 300
I ndianapolis,
1,075.98
ON ACCOUNT OF APPROPRIATION FOR
police general ufnd
Board Members
PT INVOICE NO. ACCT #fTITLE AMOUNT I hereby certify that the attached invoice(s), or
1110 12947 407 01 1,075.98 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
J� aX 21 20 10
Signature
Assistant Chief of Poli
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
a>
W Indianapolis, IN 46204
o Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Dale 05!1212010
m Invoice 00 -12888
Date Employee Description Amount Balance Due
05/03/10 Maners, Jeremy B. Hepatitis B Vaccination #3 $70.00 $70.00
Injection Fee 10.00 $10.0 D
McNair. Travis L. Hepatitis B Vaccination #3 $70.00 $70.00
Injection Fee $10.00 $10.0 0
Total Charges $16D.OD
Total Payments Balance Due $0:00' $160.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 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
$160.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 12888 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
MAY 2 4 70 10
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))
12888 $160.00
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