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Home My WebLink About199646 07/20/2011 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: $1,764.36 INDIANAPOLIS IN 46204 CHECK NUMBER: 199646 CHECK DATE: 7/20/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 15537 1,764.36 MEDICAL EXAM FEES c INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 a Indianapolis, IN 46204 o Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 07!0712011 Invoice 00 -15537 Date Employee Description Amount Balance Due 06/27/11 Jent, Danny N. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0,00 Respirator/Medical Review $16.32 $16.32 Comprehensive Ph sical Exam $99.96 $99.96 FlexibilitV Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Im Anal 14.28 $14.2B Waist/Hi Ratio 3.06 $3.06 Treadmill Submax 15&00 $156.00 Tonomet Glaucoma Test 36.72 $36.72 Vital Si ns HT WT BP P R $0.00 $0.00 V' ion PFT Pulmonary Function Test $33.66 $33.66 Audiometry 14.28 $14.28 EKG WI Interp $20.40 $20.4 0 Urinal sis Dipstick $3.06 $3.06 Martin. Brian A. Urinal sis Di stick $3.06 $3.06 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam S99.96 99.96 Muscular Strength Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.2 0 Body Ft Igst 31A ffli Imp Ana ly) $14.28 $14.2 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test 36.72 $36.72 Vital Signs HT WT BP P R WOO $0.00 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test S33.66 $33.66 Audiometry 14.28 14.28 EKG W/ Inter 20.40 $20.40 Renforth Trevor M. OnMed Program $0.00 $G.00 Health Risk AiDwaisal Motivation 0.00 $0.00 Res irator /Medical Review $16.32 $16.32 QQmprehemsive P hysicW F $99.96 $9996 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anai $14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Tonometr Glaucoma Test 36.72 $36.72 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry 14.28 14.28 EKG W Interip $20.40 204 Urinalysis Dipstick $3.06 3.06 INVOICE o Public Safety Medical Services H 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 07107!2011 m Invoice 00 -15537 Date Employee Description Amount Balance Due Semester, James S. OnMed Pro ram $0,00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 C omr)rehensiye Physical E m $9 9.96 Flexibilitv Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal $14.28 $14.28 Waistil-lip Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test 36.72 $36.72 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52. PFT Pulmonary Function Test $33.66 $33.66 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.4 D Urinalysis Di sti k $3.06 $3.06 Total Char es $1,764.36 Total Payments Balance Due $0.00 $1,764.36 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 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)) 07/07/11 15537 payment for officer physicals $1,764.36 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 N ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $1,764.36 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1110 I 15537 I 43- 407.01 $1,764.36 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 Friday, July 15, 2011 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund