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Home My WebLink About196156 03/30/2011 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $2,407.92 v CARMEL., INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 196156 CHECK DATE: 3/30/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4340700 14722 130.00 MEDICAL FEES 1110 4340701 14756 845.40 MEDICAL EXAM FEES 1110 4340701 14798 1,432.52 MEDICAL EXAM FEES INVOICE le-M r-en �i q? i 0 0 Public Safety Medical Services �*Mf 324 E. New York Street MAR 2� E Suite 300 W Indianapolis, IN 46204 o Carmel Clay Parks Recreation 1 CARMELPARK 1411E 116th Street Terms Carmel, IN 46032 Invoice Date 0310812011 m Invoice 00 -14722 Date Employee Description Amount Balance Due 03102/11 Turner, Jay D. In ection Fee 0.00 0.00 Hepatitis B Vaccination #3 $65.00 $65.0 0 03/03/11 Commons. Allie Hepatitis B Vaccination #3 $65.00 $65.00 In ection Fee $0.00 0.00 Total Charges $130.00 Total Payments Balance Due $0.00 $130.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days froth invoice date Purchase Description G1l.- P.O. P or F Purchase /0 I y,3 L- 10 70 Description G.L L Budget P.O. P or F r Line Des �G �2.5 r G.L. Purchas r Dat 3 t 0 I 1 i Budget Approval L+ne Descr Date Purchaser Date Approval 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 3!8111 14722 Medical fees 130.00 Total 130.00 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 130.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. DCCT #/TITLE AMOUNT Board Members Dept 1091 14722 4340700 130.00 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 24 -Mar 2011 Signature 130.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE t o Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Police Department I CARMEPD Terms 3 Civic Square Carmel, IN 46032 invoice Date 03116!2011 0o Invoice 00 -14756 Date Employee Description Amount Balance Due 03/07/11 Bodenhorn Wendy M. Quantiferon Tb Blood 51.00 $51.00 CMP (Comp Metabolic Panel 19.52 19.52 CBC (Comp Blood Count 17.68 17 -68 Li id Panel Blood 20.74 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood 13.26 1326 Collins Shane P. Quantiferon Tb Blood 51.00 $51.00 CMP (Como Metabolic Panel 19.52 $19.52 CBC fComip Blood Count 17.68 $17.681 Lipid Panel Blood 20.74 $20.74 Veniounctur HIV 1 2 Blood $13.26 $13.26 Driver Charles E. Quantiferon Tb Blood 51.00 $51.00 CMP (Comp Metabolic Panel 19.52 19.52 CBC (Comp Blood Count 17.68 $17.68 Lipid Panel Blood 20.74 $20.74 Veni uncture $3.06 $3.0 6 HIV 1 2 Blood 13.26 $13.26 PSA Prostate Specific A Blood 3570 $35.701 Robbins Todd Quantifer on Tb Blood 51.00 $51.0 0 CMP Com P Metabolic Panel 19.52 $19.52 CBC Com Blood Count 17.68 $17.68 L ip d Pgngl I 74 $2 0.74 Veni uncture $3.06 $3.06 Snow Donald C. Quantiferon Tb Blood $51.00 $51.00 CMP (Comp Metabolic Panel E$20- 19.52 CBC Com Blood Count 17.68 Lipid Panel Blood 20.74 Veni uncture 3.06 HIV 1 2 Blood $13.26 PSA Prostate Specific A Blood $35.70 $35.70 Stites William R. Quantiferon Tb Blood 51.00 51.00 CMP Corn Metab lic Panel 19.52 $19.52 CBC (Com12 Blood Count 17.68 $17.68 Pa nel (Bloodl $20.74 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood $13.26 $13.26 PSA Prostate Specific A Blood 35.70 35.70 Total Charges $845.40 Total Payments &Balance Due $0.00 $845.4D Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 1 k INVOICE F a Public Safety Medical Services 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 e Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 03123I2011 CIO Invoice 00 -14798 Date Employee Description Amount Balance Due 03114/11 Laker. Jeffrey W. No Show Fee $0.00 $0.00 03/18/11 Dawson, GregoryF. Quantiferon Tb Blood 51.00 51.00 CMP (Comp Metabolic Panel 19.52 $19.52 CBC (Comp Blood Count 17.68 $17.68 Lipid Panel Blood 20.74 $20.74 Veni uncture $3.06 $3.06 PSA Prostate Specific A Blood 35.70 $35.70 Driver Charles E. OnMed Program $0.00 $0. 00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16. $16.32 Co ml2rehensive Physical E xam 199.96 $99961 Flexibility Test $10.20 $10.20 BodV Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax 156.00 S156.00 Vital Si (Ins HT WT BP P R 0.00 $0.0 0 Vision AcuitV $26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry 14.28 14.28 EKG W/ Interg $20.40 20.40 Urinalysis Di stick $3.06 $3.06 Dunl Christopher T. Quantiferon Tb Blood 51.00 $51.00 Comp CIMP l P $1 9,52 13915 CBC (Comp Blood Count $17.68 $17.68 Lipid Panel Blood $20.74 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood 13.26 $13.26 Laker Jeffrey W. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.0 0 Res irator /Medical Review 16.32 $16.32 Comprehensive Ph sisal Exam $99.96 $99.96 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hip Ratio $3.06 $3.06 Treadm 5UDmax $156.00 $1 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity $26.52 1 $26.52 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinal sis Dipstick $3.06 $3.06 Robbins Todd OnMed Program 0-00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16,32 $16.32 Comprehensive Physical Exam 99.96 S99.96 Flexibility T st 10.20 10.20 Body Fat Test BIA (Bio-Elec Imp Anal 14.2 14.2 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 a) W Indianapolis, IN 46204 C Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 03123!2011 Invoice 00 -14798 Date :Employee Description Amount Balance Due WaisUHi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Vital Signs HT WT BP P R $0.00 $0.00 V $26 .52 $2652 PFT Pulmonary Function Test $33.66 $33.66 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 3.06 Total Charges $1,432.52 Total Payments Balance Due $0.00 1 $1,432.52 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 VOUCHER NO. WARRANT NO. Public Safety Medical Services ALLOWED 20 IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $2,277.92 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #ITITLF AMOUNT Board Members 1110 14755 43- 407.01 $845.40 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 1 14798 1 43- 407.01 1 $1,432.52 materials or services itemized thereon for which charge is made were ordered and received except Friday, arch 25, 2011 Chief of Police 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)) 03/16/11 14756 payment for officer physicals $845.40 03/23/11 14798 payment for office physicals $1,432.52 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