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191324 10/27/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 e ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $13,469.12 a� CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 •w;, aa'�� INDIANAPOLIS IN 45204 CHECK NUMBER: 191324 CHECK DATE: 10/27/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 13791 3,043.32 MEDICAL EXAM FEES 1120 4340701 13839 5,686.46 MEDICAL EXAM FEES 1110 4340701 13841 220.32 MEDICAL EXAM FEES 1120 4340701 13894 1,400.28 MEDICAL EXAM FEES 1110 4340701 13896 3,228.90 MEDICAL EXAM FEES 1110 4340701 CM13694 110.15 MEDICAL EXAM FEES INVOICE 0 Public Safety Medical Services 324 E. New York Street m Suite 300 IY Indianapolis, IN 46204 o Carmel Fire Department CARMEFD H 2 Civic Square Terms Carmel, IN 46032 Invoice Date 10120l2010 M Invoice 00 -13894 Date Employee Description Amount Balance Due 10/13/10 Buttler James N. Comprehensive Physical $99.96 $99.96 OnMed Program 0.00 $0.00 Health Risk Appraisal Motivation 0.00 10.00 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 $3.06 Muscle Strencith Endurance 26.52 26.52 Treadmill fPFE $156.00 $156.00 Bladder Cancer Screen $45.90 $45.90 Vita{ Sions -HT WTBPPR 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 Urinalysis Dipstick $3.06 3.06 Frye, Steven R. Comprehensive Physical $99.96 $99.96 Health Risk Appraisal Motivation 0.00 $0,00 OnMed Program $0.00 0.00 Res irator /Medical Review $16.32 $16.32 BIA Bio -Elec Im ed Anal 14.28 514.28 Flexibility Check 10.2 10.20 W i $3.06 Muscle Strength Endurance $26.52 $26.52 Treadmill (PFE) W26.52 $156.00 Bladder Cancer Screen $45.90 Vital Si ns HT WT BP P R 0.00 Vision Titmus 26.52 PFT Wllnter 33.66 Audiomet $14.28 ECG W/ Interp $20.40 $20.40 Urinalysis Dipstick 3.06 $3.06 Knott. Bruce A. Com rehensive Physical $99.96 $99.96 OnMed Pro ram $0.00 $0.00 Respirator/Medical vi w $1 6.32 Health Risk Appraisal Motivation $0.00 $0.00 BIA Bio -Elec Im ed Anal $14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Muscle Strength Endurance $26.52 $26.52 Treadmill (PFE $156.00 $156.00 Bladder Cancer Screen $45.90 $45.90 Vital Si ns HT WT BP P R $0.00 10.00 Vision Titmus $26.52 $26.52 PFT W/Intero $33.66 $33.66 Audiometr y 14.28 14.28 CG W/ intery $2Q.40 $20.40 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 r o Indianapolis, IN 46204 G Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 10/2012010 m Invoice 00 -13894 Date Employee Description Amount Balance Due Urinalysis Dipstick $3.06 $3.06 Total Charges $1,400.28 Total Payments Balance Due $0.00 $1,400.28 Please write invoice number on payment check. Our Federal Employer Identification Dumber is 35- 2079797 Balance due 15 days from invoice date INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 it Indianapolis, IN 46204 o Carmel Fire Department 1 CARMEFD F 2 Civic Square Terms Carmel, IN 46032 Invoice Date 10!1412010 m Invoice 00 -13839 Date Employee Description Amount Balance Due 10/04/10 Frye, Steven R. Lipid Panel $20.74 $20.74 Veni uncture Fee $3,06 $3.06 HIV 1 2 $13.26 $13.26 CMP $19.52 $19.52 CBC W /Dill And Plat $17.68 $17.68 Stindle Kevin P. Comprehensive Physical $99.96 $99.96 OnMed Program $0.00 Respirator/Medical Review $16.32 16.32 Health Risk Arpraisal Motivation 0.00 $0.00 Treadmill (PFE) $156.0 $156.00 Flexibility heck $10,20 $1 Waist/Hi Ratio $3.06 $3.06 Muscle Strength Endurance 26.52 $26.52 BIA Bio -Elec lm ed Anal 14.28 $14.28 Bladder Cancer Screen $45.90 $45.90 Vital Signs HT WT BP P R $0.00 $0.00 Vision Titmus $26.52 $26.52 PFT W/Interp $33.65 $33.66, Audiometry 14.28 $14.28 ECG W/ Inter 20.40 20.40 Urinalysis Dipstick $3.06 $3.06 10/05/10 Essex Cory Bladder Cancer Screen $45.90 $45.90 Vital Si HT 13P P R $0,0 Vision Titmus $26.52 $26.52 PFT W /Inter $33.66 $33.66 Audiomet $14.28 14.28 ECG WI Inter 20.40 20.40 Urinalysis Dipstick 3.06 3.06 Comprehensive Physical $99.96 $99.96 OnMed Pro ram $0.00 $0.0 0 Respirator/Medical Review $16.32 116.32 Health Risk A raisai Motivation $0.00 Treadmill (PFE) $156.00 $156,00 Flexibilitv Check $10.20 10.2 Wa st/Hip Ratio S3.06 $3.06 Muscle Strength Endurance $26.52 $26.52 BIA Bio -Elec Im ed Anal $14.28 $14.28 Hoover Anthony B. Comprehensive Physical $99.96 $99.96 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Health Risk Appraisal Motivation 0.00 0.40 Treadmill (PFE) $156.00 156.00 Flexibility Check $10.20 $10,2 0 WaistlHi Ratio $3.06 $3.06 Muscle Stren th Endurance 26.52 $26.52 BIA Bio -Elec Im ed Anal 14.28 $14.28 i INVOICE t0 Public Safety Medical Services w 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 O Carmel Fire Department 1 CARMEFD f` 2 Civic Square Terms Carmel, IN 46032 Invoice Date 1011412010 Invoice 00 -13839 Date Employee Description Amount Balance Due Bladder Cancer Screen $45.90 $45.90 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Titmus 2 $26.52 P T r ECG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 CMP $19.52 $19.52 CBC W /Diff And Plat $17.68 17.68 Lipid Panel $20.74 $20.74 Veni uncture Fee $3.06 $3. 06 HIV 1 2 $13,26 $13.26 RSA 35.70 $35.70 uantiferon Tb Gold $0.00 $0.00 10/06/10 1 Reeves Neil P. Comprehensive Physic al $99.96 $99.96 OnMed Pro ram $0.00 $0.00 Resgirato r Medicgl Revi w $16.32 $1 6.32 Health Risk Appraisal Motivation $0,00 $0.00 Treadmill (PFE) $156.40 $156.00 Flexibilitv Check $10.20 1020 Waist/Hi Ratio 3.06 3.06 Muscle Strength Endurance $26.52 $26.52 BIA Bio -Elec Im ed Anal 14.28 $14.28 Chest PAILAT Hx PPD 61.20 $61.2 0 Bladder Cancer Screen $45.90 $45.90 Vital Signs HT WT BP P R $0.00 $0.00 Vision Titmus $26.52 $26.52 PFT Wllnter 33.66 $33.66 A i m et[y $14.28 $14 ECG WI Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 j 10108/10 Butts, Renee L. HCV AB Titer He C Titer $71.40 71.40 n Hepatitis A Vacc Havrix 41 79.56 79.56 Jv In"ection Fee $10.20 $10.2 0 C'I0 5 A Callahan Mark Comprehensive Physical $99.96 $99.96 -f OnMed Program 0.00 $0.0 0 Respirator/Medical Review 16.32 16.32 Health Risk Appraisal Motivation 0.00 10.00 Treadmill (PFE) $156.00 $156.00 Flexibility Check $10.20 10.20 Waist/ Rati Muscle Strength Endurance $26.52 $26.52 BIA Bio -Elec Im ed Anal $14.28 $14.28 Bladder Cancer Screen $45.90 $45.90 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Titmus $26.52 $26.52 PFT W/Interp $33.66 $33.66 Audiometry 14.28 14.28 ti INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 IY Indianapolis, IN 46204 C Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 10!1412010 m Invoice 00 -13839 Date Employee Description Amount Balance Due ECG WI Interp $20.40 $20.40 Urinal sis Dipstick $3.06 $3.06 Castor Rick S. Comprehensive Physical $99.96 $99.96 OnMed Program $0.00 $0.00 Respirator/Medical Review 16.32 $16.32 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill (PFE) $156.00 $156.00 Flexibility Check $10.20 $10.20 Waist/Hi Ratio 106 $3,06 Muscle Stren th Endurance $26.52 $26.521 IA Bi -IcIm ped Angly) $14.28 $14. Bladder Cancer Screen $45.90 $45.90 Vital Sign HT WT BP P R 0.00 0.00 Vision Titmus $26.52 $26.52 PFT W/Interp $33.66 $33.66 Audiometry 14.28 $14.28 ECG W/ Interp $20.40 S20.40 Urinalysis Dipstick $3.06 $3.06 Frenzel Eric C. Com rehensive Physical $99.96 $99.96 OnMed Program $0.00 $0.00 Respirator/Medical Review 16.32 $16.32 Health Risk A raisal Motivation $0'Q0 T mill (PFE) $156.00 $156. Flexibilitv Check $10.20 $10.20 Waist /Hi Ratio $3.06 $3.06 Muscle Stren th Endurance $26.52 $26.52 BIA Bio -Elec Im ed Anal 14.28 $14.28 Chest PAILAT 61.20 561.2 0 Bladder Cancer Screen $45,90 $45.90 Vital Signs HT WT BP P R 0.00 0.00 Vision Titmus $26.52 $26.52 PFT W/Interlp $33.66 33.66 Audiometry 14.28 $14.28 ECG W/ Inter 20.40 $20.4 0 6 Grimes, Jeffrey A. Comprehensive Physical $99.96 $99.96 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill (PFE) $156.00 $156.00 Flexibility Check $10.20 $10.20 Waist /Hi Ratio 3.06 $3.06 Muscle Strength Endurance $26.52 $26.52 BIA Bio -Elec Im ed Anal 14.28 114.28 Chest PA/LAT $61.20 $61.20 Bladder Cancer Screen $4.5.90 45.90 INVOICE t° Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 10!1412010 m Invoice 00 -13839 Date Employee Description Amount Balance Due Vital Signs HT WT BP P R 0.00 $0.00 Vision Titmus $26.52 S2652 PFT W/Interp $33.66 $33.66 Aud iometry 142 142 ECG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Reecer, Jason L. Comprehensive Physical $99.96 $99.96 OnMed Program 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Health Risk Appraisal Motivation 0.00 $0,00 Treadmill PFE 156.00 156.00 Flexibility Check $10.20 10.20 WaistlHi Ratio $3.06 $3.06 Muscle Endurance $26.52 $26.52 BIA Bic -Eiec Im ed Anal 14.28 $14.28 B Cancer Srreen $45.90 S4 5.90 Vital Signs HT WT BP P R $0.00 $0.00 Vision Titmus $26.52 $26.52 PFT Wllnter $33.66 $33.66 Audiometry 1428 $14.28 ECG WI Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 3.06 Thordarson. Erik M. Comprehensive Physical $99.96 $99.96 OnMed Program $0.00 $O.OD Respirator/Medical Review $16.32 $16.32 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill (PFE $156.00 $156.00 Flexi 1 WaisUHi Ratio $3.06 $3.06 Muscle Strength Endurance $26.52 $26.52 BIA Bio -Eiec Im ed Analyj $14.28 $14.28 Bladder Cancer Screen $45.90 $45.90 Vital Signs HT WT BP P R $0.00 0.00 Vision Titmus 26.52 $26.52 PFT W/Interp $33.66 $33.66 Audiometry 14.28 $14.28 ECG W1 Interp $20.40 $20.40 Urinalysis Di stick $3.06 $3.06 Viehe Richard E Comprehensive Physical $99.96 $99.96 Q nMed Pr r m Respirator/Medical Review $16.32 $16.32 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill (PFE) $156.00 $156.00 Flexibility Check 110.20 $10.20 Waist/Hi Ratio $3.06 3.06 Muscle Stren th Endurance 26.52 26.52 BIA Bio -Eiec Im ed Anal 14.28 14.28 INVOICE 0 Public Safety Medical Services 324 E. New York Street Suite 300 Indianapolis, IN 46204 o Carmel Fire Department 1 CARMEFD H Terms 2 Civic Square Carmel, IN 46032 Invoice Date 1011412010 m Invoice 00 -13839 Date Employee Description Amount Balance Due Bladder Cancer Screen $45.90 $45.90 Vital Signs FIT WT BP P R $0.00 0.00 Vision Titmus $26.52 $26,52 PFT Wllnter 33.66 33.66 Audiometr 1428 $14.28 ECG W! Interlp $20.40 $20,40 Urinalysis Di stick $3.06 $3.06 Total Charges $5,686.46 Total Payments Balance Due $0.00 $5,686.46 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 .Balance due 15 days from invoice date INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department 1 CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 10/06/2010 C0 Invoice 00 -13791 Date Employee Description Amount Balance Due 09/29/10 Anderson, D. Cory Comprehensive Physical $99.96 $99.96 OnMed Program $0.00 0.00 Respirator/Medical Review $16.32 $16.32 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill (PFE) $156.00 $156.00 Flexibility Check $10.20 $10.20 Waistffl Ratio $3.06 $3.06 Muscle Strength Endurance $26.52 $26.52 BIA Bio -Elec Im ed Anal 14.28 $14.28 Chest PA /LAT $61.20 $61.20 Bladder Cancer Screen S45.2Q $4 5.90 Vital Signs HT WT BP P R $0.04 $0.00 Vision Titmus 26.52 $26.52 PFT W /Inter 33.66 33.66 Audiometry $14.28 1 $14.28 ECG W/ Inter 20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Payne. Thomas C. Comprehensive Physical $99.96 $99.96 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Health Risk A raisal Motivation 0.00 $0.00 Treadmill PFE 156.00 $156.00 Flexbility hock $10.20 $1 Waist/Hi Ratio $3.06 $3.06 Muscle Strength Endurance $26.52 $26.52 BIA Bio -Elec Im ed Anal 14.28 $14.28 Bladder Cancer Screen $45.90 $45.90 Vitai Signs HT WT BP P R $0.00 $0.00 Vision Titmus $26.52 $26.52 PFT W/Interp $33.56 $33.66 Audiometry 14.28 $14.28 ECG W/ Interp $20,40 $20.4 0 Urinalysis Di stick $3.06 $3.06 09/30/10 Bondurant Jeff S. HCV AB Titer He C Titer 71.40 $71.4 0 Hepat itis A V cc vrx 1 $79-56 $7 9.561 hection Fee $10.20 $10.20 10/01/10 Nicley, Wes W. Vital Signs HT WT BP P R $0.00 $0.00 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 Urinalysis Dipstick $3.06 $3.06 Comprehensive Physical $99.96 $99.96 OnMed Program 0.00 $0.00 Res irator /Medi al Review $16.32 $16.32 Health Risk Apgraisal Motivation 0.00 0 INVOICE t° Public Safety Medical Services 324 E. New York Street Suite 300 IY Indianapolis, IN 46204 G Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 1010612010 m Invoice 00 -13791 Date Employee Description Amount Balance Due Treadmill PFE 156.00 $156.00 Flexibility Check 10.0 10.20 Waist/Hi Ratio 13.06 $3.06 Muscle S trength Endurance 2 BIA Bio -Elec Im ed Anal $14.28 $14.28 Bladder Cancer Screen $45.90 $45.90 Robinson, Mark G. Comprehensive Physical $99.96 $99.96 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Health Risk Appraisal Motivation 0.00 $0.00 Treadmill (PFE) $156.00 $156.00 FlexibilitV Check $10.20 $10,2 0 Waist/Hi Ratio $3.06 $3.061 Muscle Strength Endurance $26.52 26.52 BIA Bio -Elec Im ed Anal 14.28 $14.28 Bladder Can Vital Signs HT WT BP P R $0.00 $0.00 Vision Titmus q$26-52 $26.52 PFT W /Inter 66 33.56 Audiomet 28 14.28 ECG W/ Inter 40 20.4 Urinal sis Di stick 06 $3,06 Walker Christopher E. Com rehensive Ph sical 99.96 99.96 OnMed Program 0.00 0.00 Respirator/Medical Review 16.32 16.32 Treadmill PFE 156.00 156.00 Flexibility Check 10.20 10.20 WaisWir) Ratio Muscle Strength Endurance $26.52 $26.52 BIA Bio -Elec Im ed Anal) $14.28 $14.28 Bladder Cancer Screen $45.90 $45.90 Vital Signs HT WT BP P R 0.00 $0.00 Vision Titmus $26.52 $26.52 PFT W/Interp 33.66 $33.66 Audiometry 14.28 $14.2B ECG Wf Interp $20.40 20.40 Urinalysis Dipstick $3.06 $3.06 Health Risk Appraisal Motivation 0.00 $0.0 0 Wendzel Jason D. Comprehensive Physical $99.96 $99.961 On Med ProQram SO.00 $000 Respirator/Medical Review $16.32 $16.32 Health Risk Appraisal Motivation $0.00 $0.00 Treadmill (PFE 156.00 156.00 Flexibility Check 426.52 0.20 10.20 Waist /Hi Ratio 3.06 $3.06 Muscle Strength Endurance 26.52 BIA Bio Elec Im ed Anal 4.28 $14.28 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Fire Department I CARMEFD t— 2 Civic Square Terms Carmel, IN 46032 Invoice Date 10/0612010 Invoice 00 -13791 Date Employee Description Amount Balance Due Vital Signs HT WT BP P R 0.00 $0.00 Vision Titmus $26.52 26.52 PFT W /Intern 33.66 $33.66 Audiornetry $14.28 $14.28 EGG W/ Inter 20.40 20.40 Urinalysis Dipstick $3.06 $3.06 Bladder Cancer Screen 45.90 45.90 Total Charges $3.043.32 Total Payments Balance Due $0:00 $3,043.32 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 $10,130.06 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 13839 43- 407.01 $5,686.46 1 hereby certify that the attached invoice(s), or 1120 13894 43- 407.01 $1,400.28 bill(s) is (are) true and correct and that the 1120 13791 43- 407.01 $3,043.32 materials or services itemized thereon for which charge is made were ordered and received except OCT 2 5, 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)) 13839 $5,686.46 13894 $1,400.28 13791 $3,043.32 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 H Public Safety Medical Services 324 E. New York Street E Suite 300 a Indianapolis, IN 46204 O Carmel Police Department/ CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 10I1412010 m Invoice 00 -13841 Date Employee Description Amount Balance Due 10/04/10 Kinkade Matthew P. CMP $15.30 $15.3 0 CBC W1Diff 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 1326 Quantiferon Tb Gold $51.00 51.00 Miller Adam C. CMP $15.30 $15.30 CBC W /Diff And Plat $12.24 $12,24 Lind Panel 15.30 15.30 Veni uncture Fee $3.06 3.06 H IV 1 1 Quantiferon Tb Gold $51.00 $51.00 Total Charges $220.32 Total Payments Balance Due $0.00 $220.32 Please write invoice number on payment check. Balance due 1.5 days from invoice Our Federal Employer Identification Number is 35- 2079797 date J Public Safety Medical Services, Inc. 324 E. N ew York INVOICE Suite 300 Invoice Number: CM-13694 Indianapolis, IN 46204 Invoice Date: Oct 7, 201 TIN 35-2079797 Page: Voice: 1-317-972-1180 Duplicate Fax: 1-317-972-1190 Carmel Police Department 3 Civic Square Carmel, IN 46032 gin NO E V A W R, B CARMEPID Net 30 Days Sales hi ��Due Date Q V X flI D S Date hio "'o Courier 1116110 Unit Frrce Amount N012_9 refund for duplicate charge for Randy -110.16 Schalburg -on invoice 00-13694 Subtotal -110.16 Sales Tax Total Invoice Amount -110.16 Check/Credit Memo No: Payment /Credit Applied am" 22.2 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 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)) 1-0/14/1C 13841 payment for officer physicals 220.32 1017110 CM13694 less credit 11.0.16 Total 11.0.16 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 VOL!CHER NO. WARRANT NO. ALLOWED 20 P ublic Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN446204 110.16 ON ACCOUNT OF APPROPRIATION FOR police general fund Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. y y e a inv oice(s), I hereby certify that the iice( s or ere 1110 13841 407 -01 220.32 bill(s) is (are) true and correct and that the 1110 CM13694 407 -01 110.16 materials or services itemized thereon for which charge is made were ordered and received except October 22 20 10 Signature Assistant Chief of Poli Titie 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 d W Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 1012012010 Invoice 00 -13896 Date Employee Description Amount Balance Due 10/11/10 Smiley, LandrV D. CMP $15.30 $15.30 CBC W1Diff And Plat $12.24 $12.24 Lipid Panel 15.30 $15.3 0 Veni uncture Fee 106 3.06 HIV 1 2 $13.26 $13,26 Quantiferon Tb Gold 51.00 $51.0 0 10/15/10 Brady,SeanP. Comprehensive Physical 9232 $92.82 Health Risk Aooraisal Motivation 16.32 $16.32 OnMed Program $0.00 $0.00 Res irator /Medical Review $16.32 $16.32 B Imped A I y) $14.28 $14.2 Flexibilitv Check $10.20 $10.20 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 26.52 $26,52 PFT WlInterp $33.66 $33.66 Audiometry $14.28 $14.28 ECG Wl Interp $20.40 $20.401 Urinalysis Di stick $3,06 $3,06 Cash Steven H. Comprehensive Physical $92.82 S92.82 QnMed Program mQ0 SO. 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 $10.20 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 $26.52 $26.52 PFT Wllnter 3166 $33.66 Audiometr $14.28 $14.28 E CG VVI Inter Interp S20.40 .4 Urinalysis Dipstick $3.06 $3.06 Dewald, Gregory S. Comprehensive Physical $92.82 $92.82 Health Risk Appraisal (Motivation) $16.32 $16.32 OnMed Program 0.00 $0.00 Res iratorlMedical 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 Tonornetry $36.72 $36.72 Vital Signs HT WT BP P R $7,14 7.14 INVOICE F Public Safety Medical Services 324 E. New York Street Suite 300 W Indianapolis, IN 46204 o Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 10/2012010 m Invoice 00- 13896 Dale Employee Description Amount Balance Due Vision Titmus $26.52 $26.52 PFT W/Interlp $33.66 $33.66 Audiometry 14.28 $14.28 ECG Intero $20.40 $20.4 Inter Urinalysis Dipstick $3.06 $3.06 Green Timothy J. Comprehensive Physical $92.82 $92.82 OnMed Proaram $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 Flexibilitv Check $10.20 110.2 0 WaisUHO Ratio $3,06 $3.06 Treadmill (PFE 156.00 $156.00 Tonomet 36.72 $36.72 Vital Si ns HT WT BP P R $7.14 $7.14 Vision Titmus $26.52 $26.52 PFT W/Interp $33.66 $33.66 Audiomet $14.28 $14.28 ECG W/ Interp $20.40 20.40 Urinalysis Dipstick $3.06 3.06 Herron. James C. 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 Rexibilit Check $10.20 $10.2 0 Waist/Hi Ratio $3.06 $3.061 T 6 1 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 W/ Interp $20.40 $20.40 Urinal sis Dipstick $3.06 $3.06 Kinkade Matthew P. Comprehensive Physical $92.82 $92.82 Health Risk Appraisal Motivation 16.32 1 $16.32 OnMed Program $0,00 0.00 R s it for /Medical Review $16.32 16.32 BIA io -EI c Imped Anal y) $14.28 $14 Flexibility Check $10.20 $10.20 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 $26,52 $26.52 PFT W/Interp $33.66 $33.66 INVOICE o Public Safety Medical Services t 324 E. New York Street E Suite 300 a) x Indianapolis, IN 46204 G Carmel Police Department! CARMEPp 3 Civic Square Terms Carmel, IN 46032 Invoice Da 10120!2010 m invoice 00 -13896 Date Employee Description Amount Balance Due Audiornetry $14.28 $14.28 ECG W( Interp $20.40 $20.40 Urinalysis Dipstick $3,06 $3.06 Smile v. Land D. Com rehensive Physical 92.82 $92.82 Health Risk Appraisal Motivation 16.32 $16.32 OnMed Pro ram 0.00 $0.0 0 Res irator ?Medical Review $16.32 $16.32 BIA Bio -Elec Im ed Anal 14.28 $14.28 Flexibility Check $10.20 $10,2 0 Waist/Hip Ratio $3.06 $3.06 Treadmill (PFE) $1 Vital Si ns HT WT BP P R $7.14 $7.14 Vision Titmus $26.52 26.52 PFT W/Interp $33.66 $33.66 Audiomet 14.28 14.28 ECG W1 Interp I S20.40 20.40 Urinalysis Dipstick 1 $3.06 3.06 Total Charges $3.228.90 Total Payments Balance Due $0.00 E$3.2�28.90 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 Public Safety Medical Services Purchase Order No. 324 E. New York Street, Suite 300 Terms Indianap6lis, IN 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 10/20/10 13896 payment for officer physicals 3,228.90 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 Ser=vices IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 3,228.90 ON ACCOUNT OF APPROPRIATION FOR police general fund Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 13896 407 -01 3,228.90 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 OcT.obdi 22 20 10 gnature Assistant Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund