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Home My WebLink About193501 01/05/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $4,832.40 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 193501 CHECK DATE: 1/5/2011 D EPARTM ENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1115 R4350900 27523 00 -14309 92.82 HEALTH SCREENINGS 1110 4340701 0014231 819.06 MEDICAL EXAM FEES 1110 4340701 0014267 3,920.52 MEDICAL EXAM FEES INVOICE o Public Safety Medical Services 324 E. New York Street Suite 300 Indianapolis, IN 46204 G Carmel Clay Communications CARMCOM 31 First Avenue NW Terms PO# 27523 invoice Date 1212912010 m Carmel, IN 46032 invoice 00 -14309 Date Employee Description Amount Balance Due 12/22/10 Coffins Mindy L. Vision Titmus $26.52 $26.52 Audiometry 14.28 14.28 Speech Discrimination 52.02 $52.02 Total Charges $92.82 Total Payments Balance Due $0.00 $92:82 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance Clue 15 days from 111v01ce date VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Ste 300 Indianapolis, In 46204 $92.82 ON ACCOUNT OF APPROPRIATION FOR Carmel Clay Communications PO# Dept. INVOICE NO. I ACCT #!TITLE AMOUNT Board Members Prior Year Encumbered I hereby certify that the attached invoice(s), or 27523 00 -14309 I 43- 509.00 I $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, January 03, 2011 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)) 12129/10 00 -14309 $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 INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 of Indianapolis, IN 46204 o Carmel Police 'Department 1 CARMEPD f 3 Civic Square Terms Carmel, IN 46032 Invoice Date 1211612010 m Invoice 00 -14231 Date Employee Description Amount Balance Due 12/06/10 Barlow, James C. CMP $15.30 $15.3 0 CBC W /Dill 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 PSA $35.70 $35.70 Howard Lana M. CMP $15.30 $15.3 0 CBC W /Dill And Plat $12.24 $12.24 Li id Panel $15.30 $15.3 0 Venwpunct re Fee $3.06 $3.06 HIV 1 2 $13.26 $13.26 Quantiferon Tb Gold $51.00 $51.00 Koebcke Chad E. Tb Read $0.00 $0.00 Zellers Nancy L. CMP $15.30 $15.30 CSC 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 12/09/10 Graham Bruce A. CMP $15.30 $15.3 0 CBC W /Dill And Plat $12.24 12.24 Li id Panel $15.30 $15.3 0 Venipunct re F S3W06 $3.06 HIV 1 2 $13.26 $13.26 PSA $35.70 $35.70 Quantiferon Tb Gold $51.00 $51.00 12/10/10 Bailey. Vicki L. Quantiferon Tb Gold 51.00 51.00 Mulli an. Laura J. Quantiferon Tb Gold $51.00 $51.00 Strong David C. CMP $15.30 $15.3o CBC W /Dill And Plat $12.24 $12.24 Ll id Panel $15.30 $15.30 Veni uncture Fee $3.06 $3.06 HIV 1 2 $13.26 $13.26 PSA $35.70 $35.70 Quan tiferon Gold Wiegman, Chad R. HIV 1 &2 $13.26 $13.26 Quantiferon Tb Gold $51.00 $51-00 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 Total Charges 1 $819.06 Total Payments Balance Due $0.00 1 $8197,706 Please write invoice number on payment check. Balance due 15 days from invoice date INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 12/22/2010 m Invoice 00 -14267 Date Employee Description Amount Balance Due 12/14110 Boles, Elizabeth L. Quantiferon Tb Gold $51.00 $51.0 0 Doan Marie L. Quantiferon Tb Gold $51.00 $51.0 0 Elliott John R. Quantiferon Tb Gold $51.00 $51.00 Goodman. Leland C. CMP $15.30 $15.3 0 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 uantiferon Tb Gold $51.00 $51.00 Hi fl. Nathaniel W CMP 1 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 Quantiferon Tb Gold 51.00 $51.00 Jable Patricia A. Quantiferon Tb Gold $51.00 $51.0 0 Scott Curtis D. CMP $15.30 $15.3 0 CBC W /Diff And Plat $12.24 $12.24 Li id Panel $15.30 $15.3 D Veni uncture Fee $3.06 $3.06 Q uantiferon Tb Gold $51.00 $51.0 0 CNIP $15.30 CBC W /Diff 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 $51.00 Zellers Timothy V. CMP $15.30 $15.3 0 CBC W /Diff And Plat $12.24 $12.24 Lipid Pane! $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,QQ $51.0 12/15/10 Care Luckie A. 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 $14.26 Flexibilitv Check $10.20 $10.2 0 Waist /Hi Ratio $3.06 $3.06 Treadmill (PFE) $156.00 $156.00 Tonornetry S36.72 $36.72 Vital Si ns HT WT BP P R $7.14 7.14 Vision Titmus $26.52 $26.52 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 12/22/2010 m Invoice 00- 14267 Date Employee Description Amount Balance Due PFT W/Interp $33.66 $33.66 Audiometry 14.28 $14.28 ECG W/ Inter 20.40 $20.4 0 rin i Dopstic Gilbert William J. Comprehensive 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 $10.20 Waist/Hi Ratio $3.06 $3.06 Treadmill (PFE) $156.00 $156.00 Tonometry $36.72 $36.72 Vital Si ns HT WT BP P R $7.14 $7.14 Vision Titmus S26.52 $26.52 T W/Interp $33.66 6 AudiometEy $14.28 $14.28 ECG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Graham Bruce A. 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 lm ed Anal 14.28 $14.28 Flexibility Check $10.20 10.20 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/Interp $33.66 $33.66 Audiomet 14.28 $14.28 ECG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Howard Lana M. 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 $14.26 Flexibility Check $10.20 $10.2 0 ti Muscle Strength 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 PFT W/Interp $33.66 $33.66 Audiometry 14.28 $14.28 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 d IY Indianapolis, IN 46204 o Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 12/22/2010 m Invoice 00 -14267 Date Employee Description Amount Balance Due ECG W! Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Keith Brett A. Comprehensive 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 Bic -Efec Imiped Anal 14.28 $14.28 Flexibility Check $10,20 $10.2 0 Waist/Hi Ratio $3.06 $3.061 Treadmill (PFE $156.00 $156.00 To 0 7 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 W/ Interp $20.40 20.40 Urinal sis Dipstick $3.06 $3.06 Leach. Aaron M. 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 -Efec Im ed Anal 14.28 $14.2 Flexibility Ch k $1 0.20 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 Vision Titmus 26.52 $26.52 PFT W/Interp $33.66 $33,66 Audiometry 14.28 14.28 ECG W/ Intero $20.4D $20.4 0 Urinalysis Dipstick $3.06 $3.06 In ection Fee $10.20 $10.2 He atitis B Vacc Booster $71.40 $71.4 0 Na ncy r n Physical $92.82 $92. Health Risk Appraisal Motivation $16.32 $16.32 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 BIA Bio -Efec Im ed Anal 14.28 $14.28 Flexibility Check $10.20 $10.20 Waist/K 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 26.2 $26.52 PFT W/Interp $33.66 $33,6 t INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 a) W Indianapolis, IN 46204 o Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 12!2212010 m Invoice 00 -14267 Date Employee Description Amount Balance Due Audiornetry n306 $14.28 ECG W/ Inter 20.40 Urinal sis Di tick 3.06 Total Charges $3,920.52 Total Payments Balance Due $OAO $3,920.52 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 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 Public Safety Medical Se rvices Purchase Order No. 324 E New York St #300 Terms Indpls, IN 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 12/16/10 0014231 payment for officer physicals 319.06 12/22/10 0014267 payment for officer physicals 2,920.52 Total 4, 739.58 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 iblic UCHER NO. WARRANT NO. ALLOWED 20 Safety Medical Services IN SUM OF 324 E New York St Indpls, IN 46204 4,739.58 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 0014267 407 -01 3,920.52 bill(s) is (are) true and correct and that the 1110 0014231 407 -01 819.06 materials or services itemized thereon for which charge is made were ordered and received except December 29, 2010 Signature Asst. Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund