186991 06/23/2010 *f CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,576.92
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 186991
CHECK DATE: 6/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 12982E 2,896.44 MEDICAL EXAM FEES
1120 4340701 13025 350.00 MEDICAL EXAM FEES
1110 4340701 13070 330.48 MEDICAL EXAM FEES
y INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
Carmel Police Department 1 CARMEPD
Terms
3 Civic Square //Q
Invoice Date
m Carmel, IN 46032 Invoice 00 -12982 I
Date ;Employee;: Description Amount Balance Due
-CMP $15.30.. $15,30
Li �id Panel 1'5.30 15.30
Veni uncture Fee I 3..0 i �3.06
HIV 1 &2 1126 13.26
i Quantiferon Tb Gold 1$51.00 1$51.00
CMP I 1$16.8d 15.30
�7 CBC 4Diff And Plat i 12.24+ 1$12,24
L bid id Panel $15.36 1$15.30
Ve i' tune Fee sitJ6 I 3.06
j 1' 2 I 1-' 6: I 13.2
i I Quantiferon Tb Go I $51.00. I$,51'.00
GMP $15.30 I $'1540
R 'CBC W /DiffAnd Plat 12.24 1$12.24
Li id Panel I 15:30 15.30
I Vehi uncture Fee I D6 I 3.06
_HIV 13.2_6., 13'26
„1 Quantiferon Tb Gold 51. 00 00
05/25/10 Hasty, Zachery R. Iniection Fee $10.20 $10.2 0
He B Booster $71.40 $71.4 0
05/28/10 Bickel Scott W. Comprehensive Ph slcal $92.82 $92.82
Health Risk Anpraisal Motivation 16.32 $16.32
OnMed Program .0
Respirator/Medical Review $16.32 $16.32
BIA Bio -Elec Im ed Anal $14.28 $14.28
Flexibility Check $10.20 $10,20
Treadmill (PFE) $156.00 $156.00
Waist/Hi Ratio $3.06 $3.06
Tonometry $36.72 $36.72
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
PFT W/Interip $33.66 $33.65
Audiomet 14.28 $14.28
G W Interp $20.40 $20.4
r' i D' ti k $3
Frost Dwight D. 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 -Eiec Im ed Anal 14.28 $14.28
Flexibility Check $10.20 $10.20
Treadmill (PFE) $156.00 $156.0 0
Waistift Ratio $3.06 $3.06
Tonometry $36,72 $36.72
Vital Si ns HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
INVOICE
o. Public Safety Medical Services
324 E. New York Street
E Suite 300
a Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPD
F- 3 Civic Square Terms 6131/6
Carmel, IN 46032 Invoice Date
m Invoice 00 -12982
Date Employee Description' Amount Balance Due
PFT W/Interp $33.66 $33.66
Audiometry 14,28 $14.28
ECG Wl Inte 20.40 $20.4 0
Urin i Di ti k
CMP $15.30 $15,30
CBC W /Dill And Plat $12.24 $12.24
Li id 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
Hartin Charles V. 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 $10.20
Waist/Hi Ratio $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 $26.521
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
Pitman Michael A. Vision Titmus $26.52 $26.52
PFT W/Intern $33.66 $33.66
Audiom t $14,28 14 28
ECG WI Interp $20.40 $20.40
Urinalysis Dipstick $3.06 $3.06
Com rehensive 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
To t 6.72 .72
Vi I i n HT WT BP P R $7.14 $7.14
Scott Curtis D. Comprehensive Physical $92.82 $92.82
Health Risk Appraisal Motivation $16.32 $16.32
OnMed Program $0.00 $0,00
Respirator/ edical 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
INVOICE
o Public Safety Medical Services
324 E. New York Street
"E Suite 300
x Indianapolis, IN 46204
o
Carmel Police Department 1 CARMEPD Terms
3 Civic Square Invoice Date �'�3��0
Carmel, IN 46032
Invoice 00 -12982
DateEmployee:' Description Amount: °Balance'Due
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
Audiornetry $14.28 $14.28
ECG W1 interp $20.40 120.4 0
Urinalysis Dipstick $3.06 $3,0 6
Vanldatter, Shane R. Comprehensive Physical $92.82 $92.82
OnMed Program $0.00 $0.00
R it t r 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 $10.20
Waist/Hi Ratio $3.06 $3,06
Treadmill (PFE) $156.00 $156.0 0
Tonometry $36.72 $36,72
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
PFT W/Interlp $33.66 1 33.68
Audiometry $14.28 $14.28
ECG W1 Interp $20.40 $20.40
Urinalysis Di ti k 6 Tq nr
3
Total= Cha;ges
Total Payment s Ba lanceD
ue a)0
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
1
INVOICE
F Public Safety Medical Services
324 E. New York Street
E Suite 300
M Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 invoice Date 06/16/2010
m Invoice 00 -13070
Date Employee Description Amount Balance Due
06/07/10 Flaminq,AnnaG. 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
06111110 Collins Larry J. CMP $15.30 $15.3 0
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
Quantiferon Tb Gold $51.00 $51.00
Smith Troy D. 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 1126
Quantiferon Tb Gold $51,00 51.00
Total Charges $330.48
Total Payments Balance Due $0.00 $330.48
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
Prescribe; 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))
6 /3/10 12982E payment for officers; h sisals 2,896. 4
6/16/10 13070 payment for office physicals 330.48
Total 3,226.92
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
P Sblis Safety Medical Services IN SUM OF
324 E. New York STreet, Suite 300
Indianapolis, IN 46204
3,2,26.9:2
ON ACCOUNT OF APPROPRIATION FOR
p olice general fund
Board Members
PO# or DEPT INVOICE NO. ACCT #/TITHE AMOUNT 1 hereby certify that the attached invoice(s), or
1110 12982E 407 -01 2,896.44 bill(s) is (are) true and correct and that the
1110 13070 407 -01 330.48 materials or services itemized thereon for
which charge is made were ordered and
received except
.Tune 16 2 0 1.0
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
INVOICE
Public Safety Medical Services
324 E. New York Street
E Suite 300
ix Indianapolis, IN 46204
0 Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel IN 46032 Invoice Date 0610312010
M Invoice 00 -13025
Date :Employee Description Amount Balance Due
05/26/10 Bowles, Orbie H. Funct Move Screen $70.00 $70.00
Butts Joseph A. Funct Move Screen $70.DO $70.0 0
Haboush David G. Funct Move Screen $70,00 $70.00
Platt Jace P. Fund Move Screen $70.00 $70.00
Small Thomas D. Funct Move Screen $70,00 $70.00
Total Charges $350:00
Total Payments Balance Due $0.00 $350.00.
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
i
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$350.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# /Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 13025 43- 407.01 $350.00 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
JUN 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))
13025 $350.00
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