166852 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $2,731.00
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 166852
CHECK DATE: 12/10/2008
D EPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBER AMOUNT DESCRIPTION
'1120 4340:702 10263 240.00 SHOTS INOCULATIONS
1110 43.40701 10264 2,491.00 MEDICAL EXAM FEES
5 �..r ..,.w.... t...,._
INVOICE
rF� Public Safety Medical Services
324 E. New York Street
<E Suite 300
m
Indianapolis, IN 46204
Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 11/25/2008
m Invoice 00 -10263
'Date.`: "!Employee Description Amount Balance °Due
11/17/08 Ray. Lucas M. Hepatitis B Vaccination 92 $70.00 $70.00
In Fee $10.00 $10,0 0
Watts, Trent E. Hepatitis B Vaccination #2 $70.00 $70.0 0
In ection Fee $10.00 $10.0 0
Woodburn. Scott E. Hepatitis B Vaccination #2 $70.00 $70.00
In ection Fee smoo 10.00
t Total Qharges >:,24Q:00
Total Payments' Balancebue t$0.00 $240:00'
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 date
VOUCHER Nn. WARRANT NO,
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 Fast New York Street, Ste. 300
Indianapolis, IN 46204
$240.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 10263 43 407.02 $240.00 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
us
zoos
'4' d
e
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))
10263 Shots Recruits $240.00
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
P` Public Safety Medical Services
r 324 E. New York Street
�E,; Suite 300
!Y. Indianapolis, IN 46204
o` Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 11/25/2008
Invoice 00 10264
Date: ;Employee Description :Amount Balance Due
11/18/08 Broadnax, Matthew L. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.0 0
Treadmill f PFE $165.00 $165.00
Body Fat Check Bod Pod $23.00 $23.00
Flexibility Check $7.00 $7.00
Muscle Strength Endurance $23.00 $23.0 0
Waist/Hi Ratio $0.00 $0.00
Leach Aaron M. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.0 0
Treadmill PFE 165.00 $165.00
B ody F t Check Bod Pod 0 $2
Flex[bilitv Check $7.00 $7.00
Waist/Hi Ratio $0.00 $0.00
Snow Donald C. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165,00
Body Fat Check Bod Pod 23.00 $23.0 0
Flexibility Checks 17.00 $7,00
Waist/Hi Ratio $0.00 $0.0 0
11/19/08 Gilbert William J. Exec 1 Wellness Offsite $61.00 $61.00
HIV 1 2 $0.00 $0.00
Q uantiferon Tb Gold $50.00 $50.0 0
Meyer, Ryan J. 10 Cities $234.00 4.
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
Body Fat Check Bod Pod $23.00 $23.00
Flexibility Check $7.00 $7.00
Waist/Hi Ratio $0.00 $0.00
Mulli an Laura J. HB SAb Quantitative Titer $35.00 35.00
Myers, Brady R. Quantiferon Tb Gold Results 50.00 $50.00
Tb Skin Test som $0.00
Pins John D. Quantiferon Tb Gold 50.00 $50.0 0
Exec 1 Wellness Offske $61.00 $61.00
V 00 0 0
�t ites, Wil Exec 1 W 1 s Offsite 1. 0 $61.
HIV 1 2 $0.00 $0.00
PSA $36.00 $36.00
Quantiferon Tb Gold $50.00 $50.0 0
Zellers. Nancy L. Exec 1 Wellness Offsite $61.00 $61.00
Quantiferon Tb Gold $50.00 $50.0 0
Zellers Timothy V. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV 1 2 $0.00 1 0.00
PSA $36.00 $36.00
Quantiferon Tb Gold 50.00 $50.00
Total Charges' $2,491.00
Total Payments Balance Due $0.00 $2,491.00
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 Services Purchase Order No.
324 P. 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))
11/25/08 10264 payment for officer physicals 2,491.00
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
2,491.00
ON ACCOUNT OF APPROPRIATION FOR
police genera lfund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 10264 407 -01 2 491 .00 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
December 5 20 08
Signature
Chief of Police
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund