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Home My WebLink About194324 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ti, ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,360.12 �i CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 194324 CHECK DATE: 2/3/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 14311 3,098.46 MEDICAL EXAM FEES 1125 4340700 14352 65.00 MEDICAL FEES 1110 4340701 14385 196.66 MEDICAL EXAM FEES INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 o Carmel Clay Parks Recreation 1 CARMELPARK Terms 1411 E 116th Street Carmel, IN 46032 Invoice Date 01/0412011 Invoice 00 -14352 Date Employee Description Amount Balance Due 12/29/10 Aleksa John R. Hepatitis B Vaccination #3 $65.00 $65.00 Iniection Fee $0.00 $0.00 Total Charges $65.00 Total Payments Balance Due $0.00 $65.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 1; days from invoice date Purchase Description hA e Cl/ P.O.# Pore (3.t_. a�- �l I U OC}l� L Ya'7 o D 1 2011 Budget tine escr as Purch r Approva 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. 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 114111 14352 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 101 -General Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1125 14352 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 27 -Jan 2011 Signature 65.00 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 E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department/ CARMEPD F 3 Civic Square Terms Carmel, IN 46032 Invoice Date 12129!2010 m Invoice 00 -14311 Date Employee Description Amount Balance Due 12/20110 Barker Matthew D. Indiana Police /Fire PERF $178.50 $178.50 Chart Review/Completion $52.00 $52.00 Chest PAILAT $61.20 $61.2 0 Tb Skin Test $7.14 $7.14 Applicant Health Screen PERF $120.16 $120,16 Dru Screen 7 GCIMS W /MRO $71.40 $71.4 0 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/Intery $33.66 $33.66 Audio ECG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Tonornetry $M72 $36.72 Pirics John D. CMP $15.30 115 .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 PSA $35.70 $35.70 uantiferon Tb Gold $51.00 $51.0 0 12/22110 Barlow James C. Com rehensive Physical $92.82 S92.82 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 $10.2 0 Waisllft 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 $26.52 $26.52 PFT W /Inter 33.66 .66 Audiomet 14.28 $14.28 ECG VVI Inter Interp $20.40 .4 Urinalysis Dipstick $3.06 $3.06 McAllister John W. No -Show Fee $40.00 $40.00 McNair Harland J. Vision Titmus 26.52 $26.52 PFT W/Interp $33.66 $33.66 Audiornetry S14.28 $14.28 ECG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3,06 Com rehensive Physical $92.82 $92.82 Health Risk Appraisal Motivation 16.32 $16.32 OnMed Pro ram $0.00 $0.0 Res irator /Medical Review $16.32 $16.32 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 w Indianapolis, IN 46204 O Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 12!2912010 m' Invoice 00 -14311 Date Employee Description Amount Balance Due BIA Bio -Elec Im ed Anal 14.28 $14.28 Flexibility Check S10.20 $10.2 0 Waist/Hi Ratio $3.06 $3.06 1 TonometrV $36.72 $36.72 Vital Signs HT WT BP P R $7.14 $7.14 Pirics John D. 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 Flexibility Check $10.20 $10.20 WaisUHi Ratio $3.06 3.06 Treadmill f PFE 156.00 $156.0 0 Tonomet $36,72 $36.72 V Signs -HT WTBPPR S7.14 $7.1 Vision Titmus $26.52 $26.52 PFT W/Interp $33.66 $33.66 Audiometry 14.28 $14.28 ECG Wl Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Schalburg, Randy S. Com rehensive Physical $92.82 $92.82 Health Risk Appraisal Motivation $16.32 $16.32 OnMed Program $0.00 0.00 Res irator /Medical Review $16.32 116,32 BIA Bio -Elec Im ed Anal 14.28 $14.28 Flexibility heck $10.20 $10.20 WamsUft Rati 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 $26.52 $26.52 PFT WAnterp $33.66 $33.66 Audiometry 14.28 $14.28 ECG W/ Inter 20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.0 6 Zellers Timothy V. Comprehensive Physical $92.82 $92.821 Health Risk Avpraisal Motivation 16.32 $16.32 OnMed Program $0.00 $0.00 R r t r Medi I Review S1 BIA Bio -Elec Im ed Anal $14.28 $14.28 Flexibility Check $10.20 $10.20 WaisUHl Ratio $3.06 $3.06 Treadmill (PFE) $156.00 $156.00 TonometrV $36.72 $36.72 Vital Signs HT WT BP P R $7.14 $7.14 Vision Titmus $26.52 $26.52 INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 12/2912010 m Invoice 00 -14311 Date Employee Description Amount Balance Due PFT W/Interp $33.66 $33.66 Audiornetry $14.28 $14.28 ECG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick 13.06 $3.06 Total Charges $3,098.46 Total Payments &Balance Due $0.00 $3,098.46 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date INVOICE 6 Public Safety Medical Services 324 E. New York Street 4 E Suite 300 w Indianapolis, IN 46204 Carmel Police Department I CARMEIRD Terms J� 3 Civic Square Invoice Date 0111112011 Carmel, IN 46032 -14385 I nvoice 00 01104111 White 11, Robert E. CMP $19.52 $19.52 QBC W/Diff And Plat $17.68 768 Lir)id Panel $20.74 $20.74 Venipuncture Fee $3.06 $3.06 Please w rite invoice number on payment check Balance due 15 doIa froro invoice Our Federal Employer |dnnUm �tionNumber |u35'2O797S7 date VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO, ACCT /TITLE AMOUNT Board Members Prior Year I hereby certify that the attached invoice(s), or 1110 14385 43- 407.01 $196.66 Prior Year bill(s) is (are) true and correct and that the 1110 14311 43- 407.01 $3 materials or services itemized thereon for 1110 14311 407.01 $3,0 .46 which charge is made were ordered and 1110 14385 43- 407.01 $1967_ eceived except Friday, January 28, 2011 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by Stale 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)) 01/11/10 14385 payment for officer physicals $196.66 12131/10 14311 payment for officer physicals $3,098.46 12/31/10 14311 payment for officer physicals $3,058.46 01/11/11 14385 payment for officer phyical $196.66 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