1911304 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $2,970.50
INDIANAPOLIS IN 46204 CHECK NUMBER: 191604
CHECK DATE: 11/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4340700 00 -13736 65.00 MEDICAL FEES
1081 4340700 00 -13840 65.00 MEDICAL FEES
1091 4340700 00 -13840 130.00 MEDICAL FEES
1081 4340700 00 -13895 65.00 MEDICAL FEES
1091 4340700 00 -13895 65.00 MEDICAL FEES
1115 4350900 27523 00 -13943 2,347.68 HEALTH SCREENINGS
1091 4340700 00 -13944 65.00 MEDICAL FEES
1115 4350900 27523 00 -13987 92.82 HEALTH SCREENINGS
1120 4340701 13693 75.00 MEDICAL EXAM FEES
INVOICE
H Public Safety Medical Services
324 E. New York Street
Suite 300
W Indianapolis, IN 46204
C Carmel Clay Parks Recreation I CARMELPARK
H 1411 E 116th Street Terms
Carmel, IN 46032 Invoice Date 0912912010
m Invoice 00 -13736
Date Employee Description Amount Balance Due
09/22/10 Bromm Catherine Hepatitis B Vaccination #2 65.00 $65.00
In ection Fee $0.00 $0.00
Total Charges $65.00
Total Payments Balance Due $0.00 1 $65.00
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.O.# poff I
G.L.
Budget C S
Line Descr
Purch
Approval Date
9.30 L-,nn
INVOICE
0 Public Safety Medical Services
324 E. New York Street
-.E Suite 300
W Indianapolis, IN 46204
o Carmel Clay Parks Recreation 1 CARMELPARK
1411E 116th Street Terms
Carmel, IN 46032 Invoice Date 1011412010
Invoice 00 -13840
Date Employee Description Amount Balance Due
10/04/10 McLean Dennis M. Hepatitis B Vaccination #2 $65.00 $65.00
Inmection Fee $0.00 $0.00
10107/10 Sandberg David S. In ection Fee $0.00 $0.00
Hepatitis B Vaccination #2 65.00 $65.00
10108(10 Roudebush. Dana R. Hepatitis B Vaccination #2 $65.00 65.00
In"ection Fee o.00 0.00
Total Charges $195.00
Total Payments Balance Due $0.00 $195.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
Purchase .l;
Description —l" l� OCT 1 J 2010
P.O. .r-- P or F
G.L.
Budget e S BY:
Line Descr
Purchaser j ate
Approval Date
9% `3 0 70
�a�l 99 ��L���oa
INVOICE
H Public Safety Medical Services
324 E. New York Street
v
Suite 300
IY Indianapolis, IN 46204
a Carmel Clay Parks Recreation/ CARMEbPAR
1411E 116th Street Terms
Carmel, IN 46032 Invoice Date 10/2012010
m Invoice 00 -13895
Date Employee Description Amount Balance Due
10113/10 Armbruster, Dawn M. Hepatitis B Vaccination 42 $65.00 $65.0 0
Iniection Fee $0.00 $0.00
10(15110 Commons Allie Hepatitis B Vaccination #2 $65.00 $65.O 0
In ection Fee 0.00 $0.00
Total Charges 1 $130.00
Total Payments Balance Due I $0.00 $130.00
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. Par F
Budget b
I�ne Qesor
Purchaser
0
OCT 2 2 1010
1pgl y 3 VD 7 0 6s. oC) BY:
[o�I- 99- g3'10 6s. o0
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
d
of Indianapolis, IN 46204
C Carmel Clay Parks Recreation I CARMELPARK
1411E 116th Street Terms
Carmel, IN 46032 Invoice Date 1012912010
m Invoice 00 -13944
Date Employee Description Amount Balance Due
10/22/10 Turner, Jo D. Hepatitis B Vaccination #2 $65,00 $65.00
In ection Fee $0.00 $0.00
Total Charges $65.00
Total Payments Balance Due $0A0 $fi5.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
NOV 0
Purchase
D- crfptlon
P.O.
G.L. P or F
Budget Q O
Line Descr t f
Purchase e
Approval Date Z I d
Date
�1 l
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.
00350364 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
9129110 00 -13736 Medical fees 65.00
10/14/10 00- 13840 Medical fees 130.00
10/14/10 00 -13840 Medical fees 65.00
10/20110 00 -13895 Medical fees 65.00
10/20/10 00 -13895 Medical fees 65.00
10/29/10 00 -13944 Medical fees 65.00
Total 455.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No,
00350364 Public Safety Medical Services Allowed 20
324 E. New York Street, Ste 300
Indianapolis, IN 46204
In Sum of
455.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center 1 108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1091 00 -13736 4340700 65.00 1 hereby certify that the attached invoice(s), or
1091 00 -13840 4340700 130.00 bill(s) is (are) true and correct and that the
1081 -99 00 -13840 4340700 65.00 materials or services itemized thereon for
1091 00 -13895 4340700 65.00 which charge is made were ordered and
1081 -99 00 -13895 4340700 65.00 received except
1 091 00 -13944 4340700 65.00
4 -Nov 2010
Signature
455.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
INVOICE
H Public Safety Medical Services
324 E. New York Street
Suite 300
w Indianapolis, IN 46204
o Carmel Clay Communications I CARMCOM
31 First Avenue NW Terms
PO# 27523 Invoice Date 1110512010
m
Carmel, IN 46032 Invoice 00 -13987
Date Employee Description Amount Balance Due
10/26/10 Paulin. Kent E. Audiometry $14.28 $14.28
Speech Discrimination 52.02 $52,02
Vision Titmus $26.52 $26.52
Total Charges $92.82
Total Payments Balance Due $0.00 �$9282
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
F0- Public Safety Medical Services
324 E. New York Street
F_ Suite 300
.a Indianapolis, IN 46204
0 Carmel Clay Communications 1 CARMCOM
31 First Avenue NW Terms
PO# 27523 Invoice Date 1012912010
act
Carmel, IN 46032 Invoice 00 -13943
Date Employee Description Amount Balance Due
10120110 Case, Darcy L. Offsite Administrative Fee 5.00 $5,00
Vision Titmus $26,52 $26,52
Speech Discrimination $52.02 $52.02
Audiometry 14.28 $14.28
Collins Ashley M. Speech Discrimination $52.02 52.02
Audiornetry $14.28 $14.28
Offsite Administrative Fee $5.00 $5.00
Vision Titmus $26.52 26.52
Earl wine. Elizabeth A. Offsite Administrative Fee 5.00 S5.00
Vision Titmus 26.52 $26.52
Speec Discrimination
Audiometry $14.28 $14.28
Moore Lavernezetta H. Offsite Administrative Fee $5.00 5.00
Vision Titmus 26.52 26.52
Speech Discrimination 52.02 52.02
Audiometry 14.28 14.28
Phillip s. Kerry N. Offsite Administrative Fee 5.00 5.00
Vision Titmus 26.52 $26.52
S eech Discrimination $52.02 $52.02
Audiometry 14.28 $14.28
Reddick Joshua P. Offsite Administrative Fee $5.00 $5.001
Vision Titmus $26.52 $26.52
Speec Discrimination S52.02 $5 2,02
Audiometry $14.28 $14.28
Smith Brian M. Offsite Administrative Fee $5.00 $5.00
Vision Titmus $26.52 $26.52
Speech Discrimination 52.02 $52.02
Audiometry 14.28 14.28
Tyler, Janice Y. Offsite Administrative Fee $5.00 $5.00
Vision Titmus $26.52 $26.52
Speech Discrimination $52.02 52.02
Audiometry 14.28 $14.28
Wolfe "Lin L Offsite Administrative Fee $5.00 $5.00
Vision Titmus $26.52 126.52
Speech Disc rimination $52.02 $52,02
Audiometry $14.28 $14.28
W ler. Ka E. Offsite Administrative Fee $5.00 $5.00
Vision Titmus $26.52 $26.52
Speech Discrimination $52.02 $52.02
Audiometry 14.28 $14.28
10/21/10 Callahan Nicholas P. Offsite Administrative Fee $5.00 $5.00
Vision Titmus $26.52 $26.521
Speech Discrimination 52.02 $52.02
Audiometry $14.28 $14.28
Gordon Peggy D. Offsite Administrative Fee $5.00 $5.00
Vision Titmus $26.52 26.52
INVOICE
a Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Clay Communications 1 CARMCOM
31 First Avenue NW Terms
PO# 27523 Invoice Date 10!2912010
m Carmel, IN 46032 Invoice 00 -13943
Date Employee Description Amount Balance Due
Speech Discrimination $52.02 $52.02
Audiomet 1428 1428
Heinzman Jr. David M. Offsite Administrative Fee $5.00 $5.00
Vision Ti 2 2 $26,52
Speech Discrimination $52.02 $52.02
Audiometry $14.28 $14.28
Jokantas John M. Offsite Administrative Fee $5.00 $5.00
Vision Titmus $26.52 26.52
Speech Discrimination 52.02 $52.02
Audiometry 14.28 $14.28
Mc Gee, William D. Offsite Administrative Fee $5.00 $5.00
Vision Titmus 26.52 26.52
Speech Discrimination $52.02 $52.02
Audiornetry $14.28 $14.28
Meyer, Amanda M. Offsite Administrative Fee $5.00 5.00
Vision Titmus 2
Speech Discrimination $52.02 $52.02
Audiometry $14.28 $14.28
Polovick, Tara L. Offsite Administrative Fee $5.00 $5.00
Vision Titmus $26.52 $26.52
Speech Discrimination 52.02 $52.02
Audiomet $14.28 $14.28
Reed Michele R. Offsite Administrative Fee 5.00 5.00
Vision Titmus 26.52 26.52
Speech Discrimination 52.02 52.02
Audiometry 14.28 14.28
Stilts Dennis Offsite Administrative Fee 5. 0 5.0
Vision Tit 2. 2 $26-52
Speech Discrimination $52.02 $52.02
Audiometry $14.28 $14.28
Walton, Marcia K. Offsite Administrative Fee $5.00 $5.00
Vision Titmus $26.52 1 $26.52
Speech Discrimination $52.02 $52.02
Audiometry 14.28 $14.28
10/22/10 Arnone Janet R. Offsite Administrative Fee $5.00 5.00
Vision Titmus $26,52 $26.52
Speech Discrimination $52.02 $52.02
Audiomet 1428 $14.28
Cran Ben'amin D. Offsite Administrative Fee 5.00 5.00
Vision it 2 $26.52
Speech Discrimination $52.02 $52.02
Audiometry $14.28 $14.28
Luckoski Todd C. Offsite Administrative Fee E6. $5.00
Vision Titmus $26.52
Speech Discrimination 52.02
Audiometr 14.28
Wen er Gar Offsite Administrative Fee $5.00
INVOICE
a Public Safety Medical Services
324 E. New York Street
E Suite 300
tr Indianapolis, IN 46204
O Carmel Clay Communications I CARMCOM
31 First Avenue NW Terms
PO# 27523 Invoice Date 10!2912010
m
Carmel, IN 46032 Invoice 00 -13943
Date Employee Description Amount Balance Due
Vision Titmus $26.52 $26.52
Speech Discrimination 52.02 $52.02
Audiometry 14.2$ $14.28
Total Charges $2,347.68
Total Payments Balance Due $0.00 $2,347.68
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Ci t� Carmel INDIANA RETAIL TAX EXEMPT PAGE
CERTIFICATE NO. 003120155 002 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, AIR
CARMEL, INDIANA 46032 2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
SM12010
Public Safety Medical Services Carmel Clay Communications
VENDOR SHIP 31 First A ve nue NW
TO
3242. New York Street, Ste 300 Carmel, IN 46032
Indianapolis, in 46204 (317) 571 -2586
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43- 509.00
1 Each Health Screening Evaluations $2,738,96 $2,738.
Sub Total: $2,738.96
f
J �j��
d
4J
Send Invoice To:
Carmel Clay Communications
31 First Avenue NW
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECTACCOUNT AMOUNT
Communications PAYMENT $2,738.96
AIR VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE ✓d C�
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL No.27523 A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT' #/TITLE AMOUNT
DEPT. I 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
20
Signature
Title
Cost `distribution ledger classification if
claim paid rnotor vehicle highway fund
V NO. WARRANT NO.
Public Safety Medical Services ALLOWED 20
IN SUM OF
324 E. New York Street, Ste 300
Indianapolis, In 46204
$2,440.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT# /TITLE AMOUNT Board Members
27523 00 -13943 43- 509.00 $2,347.68 1 hereby certify that the attached invoice(s), or
27523 00 -13987 43- 509.00 $92.82
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
Monday, November 08, 2010
Director
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))
10/29/10 00 -13943 $2,347.68
11/05/10 00 -13987 $92.82
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
3
INVOICE
Public Safety Medical Services
324 E. New York Street
Suite 300
W Indianapolis, IN 46204
c Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
M
Carmel, IN 46032 Invoice Date 09/22/2010
Invoice 00 -13693
Date Em to ee
p y Description Amaunt Balance Due
09/15/10 Miller. Scott G. Fitness Far Dut Level $75.00 $75.00
Total Charges $75.00
Total Payments 8 Balance Due $0.00 $75'.00
Please write invoice number on payment check.
Our Federai Employer identification Number is 35- 2079797
VOUCHER NO. WARRANT NO.
Public Safety Medical Services ALLOWED 20
IN SUM OF
32,; (East New York Street, Ste, 300
Indianapolis, IN 46204
$75.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 13693 43- 407.01 $75.00 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
NO -�8 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))
13693 $75.00
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
2a
Clerk- Treasurer