192212 11/23/2010 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
0 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $17,000.22
INDIANAPOLIS IN 46204
CHECK NUMBER: 192212
CHECK DATE: 11/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER A MOUNT DESCRIPTION
1110 4340701 00 -13945 110.16 MEDICAL EXAM FEES
1110 4340701 00 -13988 768.86 MEDICAL EXAM FEES
1110 4340701 27011 00 -13988 658.70 CONTRACT PAYMENTS
1081 4340700 00 -14039 65.00 MEDICAL FEES
1110 4340701 00 -14040 256.02 MEDICAL EXAM FEES
1110 4340701 00 -14099 2,752.20 MEDICAL EXAM FEES
1120 4340701 13457 11,894.12 MEDICAL EXAM FEES
1120 4340701 14038 495.16 MEDICAL EXAM FEES
INVOICE
0 Public Safety Medical Services
324 E. New York Street
.E Suite 300
iX Indianapolis, IN 46204
O Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 1012912010
m Invoice 00 -13945
Date Employee Description Amount Balance Due
10118/10 Bickel. Joseph E. CMP $15.30 $15.30
CBC W /Diif And Plat $12.24 $12.24
Li id Panel 15.30 $15.3 0
Veni uncture Fee $3.46 $3,06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
Total Charges $110.16
Total Payments Balance Due $0.00 $110:16
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice
date
INVOICE
0 Public Safety Medical Services
324 E. New York Street
:E Suite 300
m
iX Indianapolis, IN 46204
o Carmel Police Department I CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 11105!2010
M Invoice 00 -13988
Date Employee Description Amount Balance Due
10/26/10 Meyer, Ryan J. CMP 15.30 $15.30
CBC W /Difil 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
Rodriquez, Cristhian R. Indiana Police /Fire PERF $178.50 $178.50
Chart Review/Completion $52.00 52.00
Chest PA/LAT $61.20 $61.2 0
Tb Skin Test $7.14 $7.14
Agglicant ealth Screen PERF $120,16 $120,1
Drug Screen (7 GC /MS W /MRO $71.40 $71.40
Vital Signs HT WT BP P R $7.14 $7.14
Vision Titmus $26.52 $26.52
Color Vision Ishihara 26.52 26.52
PFT W/Interp 133.66 $33.66
Audiometry 14.28 $14.28
ECG W/ Interp $20.40 $20.4 0
Urinalysis Dipstick $3.06 $3.06
Tonometry $36,72 $36.72
10/29/10 Zellers. Timothy And A. Audiometry $14.28 $14.28
ECG W/ Inter 20.40 $2G.4 0
Urinalysis DiD5
Tonometr $36.72 $36.72
Indiana Police /Fire PERF $178.50 1 $178.50
Chart Review/Completion $52.00 $52.00
Chest PA/LAT $61.20 $61,2 0
Tb Skin Test $7.14 $7.14
Applicant Health Screen PERF $120,16 $120.16
Dru Screen 7 GC /MS W/MR0 71.40 $71.40
Vital Signs HT WT BP P R 7.14 7.14
Vision Titmus 126.52 6.52 26.52
Color Vision Ishihara 26.52
PFT W /Inter 3.66 33.6
Total Charges $1,427.56
Total Payments Balance Due $0.00 $1,427.56
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Police Department I CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 11!1112010
m Invoice 00 -14040
Date Employee Description Amount Balance Due
11/01/10 Fogarty. Michael D. CMP $15.30 $15.30
CBC W /Dill 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 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51,00
Keith Brett A. CMP 15.30 $15.3 0
CBC W /Dill And Plat $12.24 $12.24
Li id Panel $15.30 $15.30
Vpninunrture F 3 .0
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 51.00
Total Charges $256.02
Total Payments Balance Due $0.00 $256.02
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Balance due 15 dares from
Invoice date
INVOICE
Public Safety Medical Services
324 E. New York Street
E Suite 300
x: Indianapolis, IN 46204
C Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 11!1712010
m Invoice 00 -14099
Date Employee Description Amount Balance Due
11/08/10 Zellers. Timothy And A. Repeat Glucose. Fasting 21.00 $21.00
11/10110 Clark Sr.. Todd C. Comprehensive Physical $92.82 $92.82
Health Risk Appraisal (Motivation) 116.32 $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 $10.2 0
Waist/Hip Ratio 13.06 3.06
Treadmill (PFE $156.00 $156.0 0
Tonomet $36.72 $36.72
Vital Signs HT WT PP P 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
Gauthier. Edward B. Comprehensive Physical $92.62 $92.82
Health Risk Appraisal(Motivation) $16.32 $16.32
OnMed Pro ram $0.00 $0.00
Res irator /Medical Review $16.32 16.32
BIA Bio -Eiec Im ed Anal 14.28 $14,28
Flexibility Check $10.20 $10.20
i H' D Rati
Treadmill (PFE) $156.00 $156.00
Tonornetry $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
Audiometry 14.28 $14.28
ECG VV/ Interp $20.40 $20.40
Urinalysis Di stick 3.06 $3.06
Jellison Ryan D. Comprehensive Physical $92.82 $92.82
Health Risk Apmaisal Motivation 16.32 $16.32
OnMed Pro ram $0.00 $0.00
o e i I Review 6.32 $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 W /Inter 33.66 $33.66
Audiometry 14.28 14.28
ECG WI Interp $20.40 $20.40
Urinalysis Dipstick $3.06 $3.06
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
G Carmel Police Department I CARMEPD
3 Civic Square Terms
Carmel, IN 46032 invoice Date 1111712010
m Invoice 00 -14099
Date Employee Description Amount Balance Due
Me er. R an J. Com rehensive Ph site! $92.82 $92.82
OnMed Program $0.00 $0.00
Re irator /Medical Review $16.32 $16.32
Heal Risk A r t n $16.32 $1 6.32
BIA Bio -Elec Im ed Anal y) $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 $7.1 4
Vision Titmus S26.52 $26.521
PFT W/Intern $33.66 $33.66
Audiometry 14.28 $14,28
ECG WI Interp $20.40 120.4 0
Urinalysis Dipstick 3.06 3.06
Miller, Adam Comcrehensive 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 (Bic-Elec Im ed Anal y) 114.28 $14.28
Flexibilit Check 10.20 $10.20
Waistlft Ratio 3.06 $3.06
Muscle Stren th Endurance $26.52 $26.52
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
P FT W/Interip $33,66 $33.66
Audiometry $14.28 $14.28
ECG W/ interp $20.40 1 $20.40
Urinalysis Dipstick $3.06 $3.06
Mvers Bradv R. Com rehensive 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 $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
Audiometry 14.28 1428
ECG W/ Inter 20.40 20.40
Urinalysis Dipstick $3.06 $3.06
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Police Department 1 CARMEPD
F 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 11/17/2010
m Invoice 00 -14099
Date Employee Description Amount Balance Due
Total Charges $2,752.20
Total Payments Balance Due $0.00 $2,752.20
Please write invoice number on payment check.
Balance due 15 days from
Our Federal Employer Identification Number is 35- 2079797 Invoice date
Prescribed by State 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 i
Public Safety. Me S ervices Purchase Order No. I
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))
10/29/1( 13945 payment for officer physical 110.16
11 /5 /10 13988 payment for officer physicals 1,427.56
1
11/11/10 14040 payment for officer physicals 256.02
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 ublic Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
ON ACCOUNT OF APPROPRIATION FOR
p olic e general fund
Board Members
Po# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 139.45 407 -01 110.16 bill(s) is (are) true and correct and that the
1110 13988 407 -01 768.86 materials or services itemized thereon for
27011P 13988 407 -01 658.70 which charge is made were ordered and
1110 14 7
0040 40- 256.02 received except
1
0 f 7`
November 18 20 1.0
A z d 4ow X .4-
Signature
Chief of Police
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
ix Indianapolis, IN 46204
o Carmel Clay Parks Recreation I CARMELPARK
I 1411 E 116th Street Terms
Carmel, IN 46032 Invoice Date 11111/2010
m Invoice 00 -14039
Date Employee Description Amount Balance Due
11/03/10 Jones Joshua Hepatitis B Vaccination #1 $65.00 $65.00
Injection 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 F=ederal Employer Identification Number is 35- 2079797 Balance due 15 days from
Invoice date
Purchase
Description
P.O. P or F
G.L. -R
Budget S W�
Line Descr e
Purchas ate �U
Approval
Date 1
�o
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
11/11/10 00 -14039 Medical fees 65.00
Total 65.00
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
Voucher No. Warrant No.
00350364 Public Safety Medical Services Allowed 20
324 E. New York Street, Ste 300
Indianapolis, IN 46204
In Sum of
65.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -99 00 -14039 4340700 65.00 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
18 -Nov 2010
ignature
65.00 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
Indianapolis, IN 46204
o Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08!1912010
m Invoice 00 -13457
Date' Emp'loyeev Description Amount jBalance Due',
08111/10 Alverson Jonathon L. CMP $19.52 $19.52
CSC W /Dill And Plat $17.68 $17.68
Lipid Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.0 6
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold 51.04 $51,0 0
Bondurant Jeff S. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Lipid Panel 20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.2
PSA $35.70 $35.70
Quantiferon Tb Gold $51,00 $51.00
Ca shave Jeffrey A. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Lipid Panel $20,74 $20.74
Veni uncture Fee $3.06 $3.06
PSA $35.70 $35.70
Quantiferon Tb Gold $51,00 $51,00
Collins Ton A, CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Livid Panel $20.74 $20.74
Venlipuncture Fee $3.06 $3.06
Quantiferon Tb Gold $51.00 $51.00
Contino David M. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3,06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.0 0
Dorsch James E. CMP $19,52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Lipid Panel $20.74 $20.74
Veni un t r F
HIV 1 2 $13.26 $13.2
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.0 0
Drake Carl D. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Lipid Panel $20.74 $20.74
Veni uncture Fee 106 $3.06
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
uantiferon Tb Gold $51.00 $51.00
Fuchs Jeffery W. CMP $19.52 119.52
CBC W /Dill And Plat $17.68 $17.68
INVOICE
F�0 Public Safety Medical Services
t 324 E. New York Street
E Suite 300
d
0: Indianapolis, IN 46204
c Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08119/2010
m Invoice 00 -13457
^Date I Employee Description Amount .Balance Due
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 &2 $13.26 $13.26
Q uantiferon Tb Gold $51.00 $51.0 0
Holden Adam D. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.00
Howard Wendell E. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Lipid Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 &2 $13.26 1 11 .2
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.00
Hu hes Chad L. CMP 19.52 $19,52
CBC W /Dill 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
Quantiferon Tb Gold $51,00 $51.0 0
RBC Cholinesterase $45.90 $45.90
Hulett Mark A. CMP $19,52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20.74 $20,74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.00
Keaton Anthony R. CMP $19.52 119.52
CBC WlDiff 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
Quantiferon Tb Gold $51.00 $51.00
RBC h lin ter s 4 .9 $45.90
Lenze. Theodore A P $19,52 $19.52
CBC WlDiff And Plat $17.68 $17.68
Livid Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
RBC Cholinesterase $45.90 $45.90
Love Joseph B. CMP $19.52 $19.52
INVOICE
o Public Safety Medical Services
324 E. New York Street
Suite 300
,�W. Indianapolis, IN 46204
o Carmel Fire Department l CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 0811912010
M. Invoice 00 -13457
Date. Employee Description Amount Balanceibue
CBC W /Dill And Plat $17.68 $17.68
Lipid Panel $20.74 $20.74
Veni uncture Fee $3.06 106
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51.OD $51.0 0
RBC Cholinesterase $45.90 $45.90
Lux Michael T. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veniguncturg F
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51,0 0
Oran a Douglas D. CMP $19.52 $19.52
CBC W /Diff And Plat $17.68 $17.68
Li id Panel $20.74 120.74
Veni uncture Fee $3.06 $3.0 6
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Q uantiferon Tb Gold $51. $51.0 0
Osborne, K. CMP $19,52 $19.52
CBC W Diff And Plat $1T $17,68
Lipid Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV i 2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.0 0
Price Joseph R 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
PSA $35,70 $35.7
Qu antiferon Tb Gold
Small, Thomas D. CMP $19.52 $19.52
CBC W /Diff And Plat E20. 17.68
Lipid Panel 20.74
Veni uncture Fee $3.06
HIV 1 2 13.26
PSA 35.70
Quantiferon Tb Gold $51.00 151.00
Starr Gre o A. CMP $19.52 $19.52
CBC W /Diff And Plat 17.68 $17.68
Lipid Panel $20.74 $20.741
Veni uncture Fee $3.06 3.06
INVOICE
o Public Safety Medical Services
324 E. New 'Fork Street
E Suite 300
0
W Indianapolis, IN 46204
c Carmel Fire Department I CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08119/2010
m Invoice 00 -13457
Date Employee Description Amount
�Balance.Due
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Tb Review Hx Positive Questionnaire $0,00 $0.00
Utzia. Todd T. 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
Quantiferon Tb Gold $51.00 $51.0 0
Watts Trent E. CMP $19.52 $19.52
CBC W /Dill 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
Q uantiferon Tb Gold $51,00 $51.0 0
W nn Barbara M. CMP $19. $19.52
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
Young, Alan R. CMP $19.52 $19.52
CBC W /Dill 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
PSA $35,70 $35.70
Q uantiferon Tb Gold $51.00 $51.0 0
Zeller Michael J. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Lipid Panel $74 20.74
Veni uncture Fee 06 3.06
HIV 1 &2 26 13.26
Qua ntiferon Tb Gold 00 51.0 08/12/10 Baile Mark E. CMP 52 $19.52
CBC W /Dill And Plat $17,68 17.68
Lipid Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13,26 $13.2
PSA $35.70
Quantiferon Tb Gold $51.00 $51.00
Baskerville Steven P. CMP $19.52 $19.52
CBC W /Dill 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
PSA $35.70 $35.70
INVOICE
to- Public Safety Medical Services
324 E. New York Street
E.. Suite 300
Ix Indianapolis, IN 46204
Carmel Fire Department! CARMEFD Terms
2 Civic Square Invoice Date 0 811 912 0 1 0
m Carmel, IN 46032 Invoice 00 -13457
Date Employee Description Amount Balance Due.
Quantiferon Tb Gold $51.00 $51.00
Benbow, KiD S. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Lipid Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.0 6
HIV 1 2 113.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
Bowles Orbie H. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Venipuncture F ee $3.06 $3.0 6
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.00
RBC Cholinesterase M$45.90 45.90
Brant Kenneth E. RBC Cholinesterase 45.90
CMP 19.52
CBC W /Dill And Plat 17.68
Li id Panel $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 &2 $13.26 $13.2
PSA $35.70 $35.70
Qu antiferon Tb GgId $51.00 1
Brisco Michael D. CMP $19.52 $19.52
CBC W /Dill 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
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.0 0
Cummins Frank C, CMP 19.52 $19,521
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Venipuncture F 3.0
HIV 1 &2
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.00
Davis James M. CMP $19.52 $19,52
CBC W /Dill 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
PSA $35.70 $35.70
Q uantiferon Tb Gold $51.00 $51.0 0
Hay maker. Samuel K. CMP 19.52 $19.52
CBC W /DiffAnd Plat $17.68 $17.68
INVOICE
Public Safety Medical Services
324 E. New York Street
E Suite 300
(D
x Indianapolis, IN 46204
G Carmel Fire Department CARMEFD
t- 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/19/2010
m Invoice 4 00 -13457
Date Employee Description Amount Balance Due
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 S3.06
HIV 1 &2 $13.26 $13.26
PSA $35.70 3570
Quantiferon Tb Gold $51.00 $51.00
Hutchison Brian R CMP $19.52 1 $19.52
CBC W /DiffAnd Plat $17.68 $17.68
Lipid Panel $20.74 $20.74
Veni uncture Fee $3.Q6 $3.061
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
Martin David D. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Lipid Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.061
HIV 1 &2 13.26 $13.2
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.00
Martin Richard A. 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
PSA $35.70 $35.70
Q uantiferon Tb Gold $51.00 $51.00
Mason Bryan L. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Lipid Panel 120.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
McNeely Michael W. CMP $19.52 $19.52
CBC W /Dill And Plat 17.68 $17.68
Li id Panel 20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 13.26 13.26
Q uantiferon Tb Gold $51.00 $51.0 0
Mead David L. CMP 19.52 $19.52
G BQ W Diff And Plat $17,68 $17.
Lipid Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
PSA $35,70 $35.70
Quantiferon Tb Gold $51.00 $51.00
Moriarty, John F. CMP $19.52 $19.52
CBC W /Diff And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
INVOICE
o; Public Safety Medical Services
324 E. New York Street
Suite 300
W
a Indianapolis, IN 46204
Q Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/19/2010
m' Invoice 00 -13457
:.Date Employee Description Amount Balance Due;
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
PSA $35,70 $35.70
Quantiferon Tb Gold $51.00 $51.00
Peterson Vernon A. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Lipid Panel $20.74 20.74
Veni uncture Fee $3.06 $3.D6
HIV 1 2 $13.26 $13.26
Q uantiferon Tb Gold $51.OD $51.001
-Re)t nolds. Shawn J. CMP $19.52 $19.521
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee 3.06 $3.06
HIV 1 2 13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 51.00
Schooley Dustin D. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.2
antiferon Tb Gold 51.00
Sharp Adam C. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $2D.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13,26 $13.26
Quantiferon Tb Gold 51.00 $51.00
Toney, James D. CMP $19.52 $19,52
CBC W /Dill And Plat $17.68 17.68
Li id Panel $20,74 20.74
Veni uncture Fee $3.06 106
HIV 1 2 $13.26 $1 3.26
PSA $35.70 $35.7
Quantiferon Tb Gold $51.00 $51.00
RBC Cholinesterase $45.90 $45.90
VanVoorst Robert J. CMP 19.52 $19.52
CBC W /Dill And Plat $17.68 17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Q uantiferon Tb Gold $51.00 $51.00
RBC Cholinesterase $45.90 $45.90
Weaver Virgil L. CMP $19.52 $19.52
INVOICE
o Public Safety Medical Services
324 E. New York Street
Suite 300
Indianapolis, IN 46204
o: Carmel Fire Department I CARMEFD
�t_ 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/19/2010
Invoice 00 -13457
Date Employee` Description Amount Balance Due
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 1126 $13.26
Quantiferon Tb Gold $51-00 $51.00
Weddin ton Kurt L. CMP $19.52 $19.52
CBC WIDiff 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
PSA $35.70 $35.70
Quantiferon Tb Gold 51.00 $51.0 0
08/13/10 Allen Brad A. CMP $19.52 $19.52
CBC W /Dill And Plat 17.68 $17.68
Li id Panel S20.74 $20.74
Venbuncture F e
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
Baskerville Anthony A. CMP 119,52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
Buttler. James N. CMP $19.52 $19.52
CBC WIDiff And Plat 17.68 17.68
Li id Panel 20.74 20.74
Veni uncture Fee 3.06 3.06
HIV 1 &2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
Callahan Mark CMP 19.52 $19.52
CBC W /Dill 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
PSA 35.70 35.70
Q uantiferon Tb Gold $51,00 $51.00
Castor Rick S, CMP $19.52 $19.52
BC W iff And Plat $17.68 $17,6
Li Did Panel 20.74 S20.7
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
PSA $35,70 $35.70
Quantiferon Tb Gold $51.00 $51.00
Crane Barry L. CMP $19.52 $19.52
CBC W /Dill And Plat 17.68 $17.68
Li id Panel $20.74 $20,74
INVOICE
o: Public Safety Medical Services
-w 324 E. New Fork Street
E Suite 300
Indianapolis, IN 46204
.0 Carmel Fire Department I CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08119!2010
m Invoice 00 -13457
Date Employee Description Amount Balance Due
Veni uncture Fee $3.06 $3.06
HIV 1 &2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.0 0
Crisler, John H. CMP $19,52 $19.52
CBC W1Diff And Plat $17.68 $17.68
Lipid Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.0 6
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Qua nfiferon Tb Gold $51,00 $51.0 0
Foster James P. 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
PSA $35.70 $35,70
Quantiferon Tb Gold $51.00 $51.0 D
RBC Cholinesterase $45,90 $45.90
Frenzel Eric C. CMP $19.52 $19.52
CBC W /Diff And Plat $17.68 $17.68
Li id Panel 20.74 $20.74
Veninunct
HIV 1 &2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold 51.00 $51.00
Griffin Timothy M. CMP $19.52 $19.52
CBC W /Diff And Plat $17.68 $17.68
Li id Panel $20.74 $20.741
Veni uncture Fee 13.06 $3,06
HIV 1 2 $13.26 $13.26
Q uantiferon Tb Gold $51.00 $51.0 0
Grimes Jeffrey A. CMP $19.52 $19.52
CBC W Diff And Plat $17.68 $17.
Li6d P $2 $2
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold 51.00 $51.00
RBC Cholinesterase $45.90 $45.90
Haus Joshua S. 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 $13.261
Q uantiferon Tb Gold $51,00 51.00
INVOICE
F Public Safety Medical Services
324 E. New York Street
E Suite 300
Ix Indianapolis, IN 46204
Carmel Fire Department 1 CARMEFD Terms
2 Civic Square invoice Date 08119/2010
m Carmel, IN 46032 Invoice 00 -13457
Date J' :i.Employee Description Amount Balance Due
RBC Cholinesterase $45.90 $45.90
Holubik Steven W. CMP 119.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20,74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold 51.00 $51.0 0
RBC Cholinesterase 45.90 $45.90
Johnson Jeremy S. CMP 19.52 $19.5 2
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
Q uantiferon Tb Gold $51.00 51.00
K Troy MP $1 $1
CBC WIDiff And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3,06 3.06
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51,00 $51.00
RBC Cholinesterase $45.90 $45.90
Medlen Michael J. CMP $19.52 $19.52
CBC W /Diff And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.00
RBC Cholinesterase $45.90 $45.90
Mitchell James C. CMP $19.52 $19.52
CBC WIDiff 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
Q uantiferon Tb Gold $51,00 $51.00
Nicley, Wes W. CMP $19.52 119.52
CB W Diff And Plat $1T68 $17,
Upid. Panel M$20.74 2 74
Veni uncture Fee $3.06
HIV 1 2 $13.26
Quantiferon Tb Gold 51.0 Philli s Crai M, CMP $19.52
CBC WIDiff And Plat $17.68 17.68
Lipid Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
+v
K. Indianapolis, IN 46204
Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08!1912090
m Invoice 00 -13457
Date Employee Description Amount Balance Due
HIV 1 2 $13.26 $13.26
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.0 0
Platt Jace P. CMP $19.52 $19.52
CBC WIDiff And Plat $17.68 $17.68
Lipid Panel $20.74 $20,74
Veni uncture Fee $3.06 $3.06
PSA $35.70 $35.70
Q uantiferon Tb Gold $51.00 $51.00
Re ert Ian T. CMP $19.52 19.52
CBC W Diff And Plat $17.6g $17.
Lipid Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 $51.00
Robinson Mitchell L CMP $19.52 $19.52
CBC WIDiff And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.0 6
HIV 1 2 $13,26 $13.26
PSA $35.70 $35.70
Q uantiferon Tb Gold 51.00 $51.00
Spe lbring. James E CMP S19.52 $19.52
CBC WIDiff And Plat $17.68 $17.68
Lipid Panel $20.74 $20.74
Veni uncture Fee 106 $3.06
PSA $35.70 $35.70
Quantiferon Tb Gold $51.00 $51.0 0
Steele Jeffrey A. CMP $19.52 $19.52
CBC WIDiff And Plat $17,68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
PSA $35.70 $35.70
Q uantiferon Tb Gold $51,00 51.
Stindle. Kevin MP $19.62 $19.52
CBC WIDiff And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13,26
Quantiferon Tb Gold $51.00 51.00
RBC Cholinesterase 45.90 $45.90
Viehe Richard E. CMP 19.52 $19.52
CBC WIDiff And Plat 17.68 $17.68
Livid Panel 20.74 $20.74
Veni uncture Fee 3.06 $3.06
HIV 1 2 $13.26 13.26
INVOICE
'6 Public Safety Medical Services
s 324 E. New York Street
E Suite 300
Q Indianapolis, IN 46204
O Carmel Fire Department! CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 0811912010
m Invoice 00 -13457
Date Employee Description Amount Balance Due
PSA $35.70 $35.70
uantiferon Tb Gold $51.00 $51.00
Woodburn Scott E. CMP $19.52 $19.52
CBC W /Dill And Plat $17.68 $17.68
Li id Panel $20.74 $20.74
Veni uncture Fee $3.06 $3.06
HIV 1 2 $13.26 $13.26
Quantiferon Tb Gold $51.00 51.00
Total Charges $11,894.12
Total Payments, &Balance Due..;> $0,00, $11,894.12
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
m
cr Indianapolis, IN 46204
o Carmel Fire Department CARMEFD
I' 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 11!11!2010
m Invoice 00 -14038
Date Employee Description Amount Balance Due
11103110 Force. Jason S. Comprehensive Physical $99.96 $99.96
OnMed Program $0.00 $0.00
Health Risk Appraisal Motivation 0.00 $0.00
Respirator/Medical Review 16.32 $16.32
CDL Form $25.00 $25.00
BIA Bio -Elec Im ed Anal $14.28 $14.28
Flexibility Check $10.20 $10.20
Waist/Hi Ratio $3.06 $3,06
Muscle Strength Endurance $26.52 $26.52
Treadmill (PFE) $156.00 $156.00
Bladder Cancer SqLQgo 4 90 $45.9
Vital Signs HT WT BP P R $0.00 $0.00
Vision Titmus 26.52 $26.52
PFT Wllnter $33.66 $33.66
Audiometry 14.28 $14.281
ECG W1 Inter 20.40 2040
Urinalysis Dipstick $3.06 $3,06
Total Charges $495.16
Total Payments Balance Due $0.00 $495.1fi
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
$12,389.28
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT
Board Members
1120 13457 43- 407.01 $11,894.12 1 hereby certify that the attached invoice(s), or
1120 14038 43- 407.01 $495.16 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
wn9. 9 2ntn
A
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))
13457 $11,894.12
14038 $495.16
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and f have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer