188018 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
s Q� CHECK AMOUNT: $6,055.52
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 188018
CHECK DATE: 7/2112010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4340700 00 -13069 25.00 MEDICAL FEES
1120 4340701 13114 999.96 MEDICAL EXAM FEES
—1120 4340701 13170 4,900.00 MEDICAL EXAM FEES
11 4340701 13221 130.56 MEDICAL EXAM FEES
INVOICE
0 Public Safety Medical Services
324 E. New York Street
Suite 300 ;V
Indianapolis, IN 46204 JUN'
,o
Carmel Clay Parks Recreation 1 CARMELPARK Terms
1411 E 116th Street
Carmel, IN 46032 Invoice Date 06/1612010
m Invoice 00.13069
Date Employee Description Amount Balance Due
06/07/10 1 Atkinson, Lindsay V. HB SAb Quantitative Titer $25.00 $25.00
Total Charges
Total Payments &:Balance Due $0:00 $25.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
Purchase
Description
P.Q. P or F
G.L.
Budget
Line Descr
Purchaser Date
Approval Date
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Public Safety Medical Services Terms
324 E. New York Street, Ste 300
Indianapolis, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/16/10 00 -13069 Medical test 25.00
Total 25.00
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Y
Voucher No. Warrant No.
Public Safety Medical Services Allowed 20
324 E. New York Street, Ste 300
Indianapolis, IN 46204
In Sum of$
25.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #TrlTLE AMOUNT Board Members
Dept
1091 00 -13069 4340700 25.00 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
15 -Jul 2010
Signature
25.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
INVOICE
o Public Safety Medical Services
324 E. New York Street
E. Suite 300
a: Indianapolis, IN 46204
G Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 07108/2010
E Invoice 00 -13221
Date Employee Description Amount Balance Due
07/02110 Spillman, R. Scott CMP $15.30 $15.30
CBC W /Dill And Plat $12.24 $12.24
Li id Panel 15.30 153 0
Veni uncture Fee $3.06 $3.06
HIV 1 2 $1326 $13.26
PSA 3570 $35.70
HB SAb Quantitative Titer $35.70 35-70
Total Charges 1 $130.56
Total Payments &Balance Due $0.00 1 $130:56
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. 261 (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))
7/8/10 13221 payment for officer physical 130.56
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
P ut'iic Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
130.56
ON ACCOUNT OF APPROPRIATION FOR
p olice general fund
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 13221 407 -01 130.56 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
July 16 20 10
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
G Carmel Fire Department CARMEFD
l 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 06!2912010
E Invoice 00.13170
Date Employee Description Amount Balance Due
06/15/10 Allen, Brad A. Exercise Prescription $35.00 $35.00
Alverson. Jonathon L. Exercise Prescription $35.00 $35.0 0
Anderson D. CoN Exercise Prescri tion 35.00 $35.0 0
BaiieV, Mark E. Exercise Prescription $35.00 $35.00
Bartrom Brad A. Exercise Prescription $35.00 $35.00
Baskerville Anthony A. Exercise Prescription $35.00 $35.0 0
Baskerville Steven P. Exercise Prescription $35.00 $35.0 0
Benbow, Kip S. Exercise Prescription $35.00 $35.0 0
Bondurant Jeff S. Exercise Prescription $35.00 $35.0 0
Bowles Orbie H. Exercise Prescription 35.00 S35.001
Brandt, D. Exercise Pr s ri tin $35.00 35.0
Brant Kenneth E. Exercise Prescription $35.00 $35.00
Brisco. Michael D. Exercise Prescription $35.00 $35.00
Buttler, James N. Exercise Prescription $35.00 $35.00
Butts Joseph A. Exercise Prescription $35.00 $35.00
Callahan Mark Exercise Prescription $35.OG $35.00
Ca Shaw Jeff rey A. Exercise Prescription 35.00 $35.00
Castor Rick S. Exercise Prescription $35.00 $35.00
Collins Ton A. Exercise Prescription $35.00 $35.Do
Conner. Timothy L. Exercise Prescription 35.00 $35.00
Contino David M. Exercise Prescr. tion $35.00 $35,001
Cox Justin M. Exercise Prescription 35.00 $35.0d
C rane. Barry L. Exercise Prescription S35.00 $35.0 0
Crisler, John H. Exercise Prescription $35.00 $35.00
Cromlich Mark A. Exercise Prescription $35.00 $35.00
Cummins. Frank C. Exercise Prescription $35.00 $35.00
Davis James M. Exercise Prescription $35,00 $35.00
DeCrastos Richard A. Exercise Prescription $35.00 $35.00
Deitsch. Marc W. Exercise Prescription $35.00 $35.0 0
DeLong, Michael T. Exercise Prescription $35.00 $35.0 0
Dorsch. James E. Exercise Prescription 35.00 $35.0 0
Drake Carl D. Exercise Prescription $35.00 $35.00
Dufek Gary J. Exercise Prescri Lion $35.00 35.00
E dwards, D ni I E Exercise Pre ri tin $35.00 $35.0 0
Edwards, Steven L Exercise Prescripti $35.00 $35.0
Ellison Christopher M. Exercise Prescription $35.00 $35.00
Essex CM C. Exercise Prescription $35.00 $35.00
Fa in Timothy D. Exercise Prescription $35.00 $35.00
Fisher GarV L. Exercise Prescniption $35.00 $35.00
Foster James P. Exercise Prescription $35.00 $35.0 0
Freer Keith T. Exercise Prescription $35.00 $35.00
Frenzel, Eric C. Exercise Prescription $35.00 $35.00
Frost Bruce S. Exercise Prescription $35.00 $35.00
Frye, Steven R. Exercise Prescription $35.00 $35.00
Fuchs Jeffery W. Exercise Prescri tion $35.OD $35.00
Gehlbach Marc A. I Exercise Prescription $35.00 $35.0 0
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
w Indianapolis, IN 46204
C Carmel Fire Department/ CARMEFD
f' 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 06!2912010
m Invoice 00 -13170
Date Employee Description Amount Balance Due
Giles William G. Exercise Prescri tion $35.00 $35.00
Gi son Bruce E. Exercise Prescription S 35.00 $35.00
Griffin Timothv M. Exercise Prescription $35.00 35.00
Grimes Jeffrey A. Exercise Pr ri tin $35,00 $35.
Gu el, Mark E. Exercise Prescription $35.00 $35.00
Haboush David G. Exercise Prescription $35.00 $35.00
Harrington. Adam C. Exercise Prescription $35.00 $35.00
Haus Joshua S. Exercise Prescription $35.00 $35.00
Haymaker, Samuel K. Exercise Prescription $35,00 $35.6 0
Hensley, Robert P. Exercise Prescription $35.DO $35.00
Holden Adam D. Exercise Prescription $35.00 $35.DO
Holubik, Steven W. Exercise Prescription $35.OD $35.001
Hoover Anthony B. Exercise Prescription 35.00 $35,0 0
Horner David W. Exercise Prescription $35.00 $35.0 0
Howard Wendell E. Exercise Prescription $35.00 s35,6o
Hu hes Chad L. Exercise Prescription $35.00 $35.0 0
Hulett, Mark A. Exercise Prescription $35.00 $35.00
Hutchison Brian P. Exercise Prescription $35.00 $35.00
Johnson Jeremv S. Exercise Prescription $35.00 $35.00
Keaton Anthony R. Exercise Prescription $35.00 $35.0 0
Kelsheimer, Troy W. Exercise Prescription $35.00 $35.00
Kilburn Roger L. Exercise Prescription $35.00 $35,00
Kinney, Jared N. Exercise Prescription $35.DO $35,OC
Knott Bruce A. Exercise Prescription $35.00 $35,0 0
Lenze Theodore A. Exercise Prescription $35.00 $35.00
Love Jose h B. Exercise Prescr tion $35.00 $35.00
Lux Michael T. Exercise Prescription $35.00 $35,0 0
Marcum, Bradley D. Exercise Prescripti $35.00 $35.00
Maroon, Ernie R. Exercise Prescription $35.00 $35.00
Marsh Michael A. Exercise Prescription $35.00 $35.00
Martin David D. Exercise Prescription $35.00 $35.00
Martin Richard A. Exercise Prescription $35.00 $35.00
Mason Bryan L. Exercise Prescription $35.00 $35.00
McNab John D. Exercise Prescription $35.00 $35.00
McNeely, Michael W. Exercise Prescription $35.00 $35,00
Mead David L. Exercise Prescription $35.00 $35.D 0
Mead Jr. Donald R. Exercise Prescription $35.00 $35.0 0
Medlen, Michael J. Exercise Prescription $35.00 $35.00
Mitchell, s C. Exercise Pres ri tion $35.00 $35.0
Moriarty, J12hn P. Exercise Prescription $35,00 $35.0
Mulford David A. Exercise Prescription $35.00 $35.00
Nicley, Wes W. Exercise Prescription $35.00 $35.00
Orange, Douglas D. Exercise Prescription $35.00 $35.00
Osborne, Scott K. Exercise Prescription $35,00 $35.00
Paddock Ronald D. Exercise Prescription $35.00 $35.0 0
Payne, Thomas C. Exercise Prescription $35.00 $35.0 0
Peterson, Vernon A. Exercise Prescription $35.00 $35.0 0
INVOICE
r° Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
G Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 06!2912010
m Invoice 00 -13170
Date Employee Description Amount Balance Due
Phillips Craig M. Exercise Prescription $35.00 $35.00
Platt Jace P. Exercise Prescription $35.OG $35,0 0
Plumer, Charles J. Exercise Prescription $35.00 35.OD
Price. Joseph P. Exercise Prescription $35.00 $35.00
Ray. Lucas M. Exercise Prescription $35.0 $35.00
Reecer, Jason L. Exercise Prescription $35.00 $35.00
Reeves Neil P. Exercise Prescription $35.00 $35.00
Reeves Ste hen J. Exercise Prescription $35.00 $35.00
Re ert Ian T. Exercise PrescHiption $35.00 $35.00
Re nolds Shawn J. Exercise Prescri tion $35,00 $35,00
Robinson Mark G. Exercise Pre.5cription $35.00 0
Robinson Mitchell L. Exercise Prescription $35.00 $35.00
Rohr Christopher M. Exercise Prescription $35.00 $35.00
R an, Christopher D. Exercise Prescription $35.00 $35.00
Schooley Dustin D. Exercise Prescription $35.00 $35.00
Sharp, Adam C_ Exercise Prescription $35.00 $35.0 0
Small, Thomas D. Exercise Prescription $35.00 $35.00
Smith Brian E. Exercise Prescription $35.00 $35.00
Sombke Brad D. Exercise Prescri tion $35.00 $35.00
Spellbring, James E. Exercise Prescription $35.00 $35.00
Starr. Gre o A. Exercise Prescription $35.00 $35.0 0
Steele Jeffrey A. Exercise Prescription $35,00 $35,00
Steu Kent Q. Exercise Prescription $35.00 $35,0
Stindle, Kevin P. Exercise Prescription $35.00 $35.00
Stroup, Scott A. Exercise Prescription $35.00 $35.00
Sutton Sean B. Exercise Prescription $35.00 $35.00
Thompson, James L. Exercise Prescription $35.D0 $35.00
Tierney, Scott A. Exercise Prescription 35.00 35.00
Tone James D. Exercise Prescription 35.00 $35.0 0
Utzig, Chad M. Exercise Prescription $35.00 $35.00
Utzig, Todd T. Exercise Prescription $35.00 $35.0 0
Vallone Frank Exercise Prescription $35.00 $35.0 0
VanVoorst Robert J. Exercise Prescription $35.00 $35.0 0
Vi he Richard E. Exercise Prescripti $35,D
Voskuhl. Mark J. Exercise Pres ri tion $35.00 $35.
Walker, Christopher E. Exercise Prescription $35.00 $35.00
Weaver Virgil L. Exercise Prescription $35.00 $35.00
Webb Gregory A. Exercise Prescription $35.00 $35.00
Weddin ton Kurt L. Exercise Prescription $35.00 $35.0 0
Wendzel Jason D. Exercise Prescription $35.00 $35,00
Whitaker Charles E. Exercise Prescription $35.00 $35.0 0
Workman William J. Exercise Prescri tion $35.00 35.00
W ant Andrew D. Exercise Prescri tion $35.00 $35.0 0
Wynn, Barbara M. Exercise Prescription $35.00 35.00
Young, Alan R. Exercise Prescription $35.Q0 S35.00
YounQ. Andrew S I Exercise Prescription $35.00 35.00
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
o Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 In ✓nice Date 06]29/2.010
m Invoice 00 -93170
Date :Employee Description Amount Balance Due
Zeller, Michael J. Exercise Prescription $35.00 $35.00
Total Charges $4,9D0.00
Total Payments Balance Due $0.00 $4,900.00
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number Is 35- 2079797 date
INVOICE
F o Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
o Carmel Fire Department I CARMEFD
Terms
2 Civic Square
Carmel, IN 46032 Invoice Date 06/22/2010
Invoice 00 -13114
Date Employee Description Amount Balance Due'
06/15110 Haboush David G. Exercise Training 4 Hrs $333.32 $333.32
06/16/10 Haboush David G. Exercise Training 4 Hrs $333.32 $333.32
06/17/10 Haboush David G, Exercise Training 4 Hrs $333.32 $333.32
Total Charges $999.96
Total Payments Balance Due $0.00 $999.96
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days front invoice
dare
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 40204
$5,899.96
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO Dept, INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 13114 43- 407.01 $999.96 1 hereby certify that the attached invoice(s), or
1120 13170 43- 407.01 $4,900.00 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
JuL 1 9 2nin
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))
13114 $999.96
13170 $4,900.00
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