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Home My WebLink About166355 11/24/2008 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 0 sf ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $8,459.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 166355 CHECK DATE: 11/24/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AM DESCRIPTION 1115 4350900 10112 138.00 OTHER CONT SERVICES 1115 R4.35`0900 16554 10112 2,112.00 HEALTH SCREEN EVALUAT 1110 434 0701 10163 430.00 MEDICAL EXAM FEES 1110 4340701: 10221 924.00 MEDICAL EXAM FEES 1110 4340701 10222 4 MEDICAL EXAM -FEES I y INVOICE Public Safety Medical Services 324 E. New York Street ':E Suite 300 .d ;p�;: Indianapolis, IN 46204 Carmel Clay Communications 1 CARMCOM 31 First Avenue NW Terms m Carmel, IN 46032 Invoice Date 11/03/2008 Invoice 00 -10112 ;Employee Description Amount Balance'Doe;; 10/20/08 Akers, William P. Audiometry W/Discrim i nation $65.00 $65.00 Vision Titmus $15.00 $15.00 Offsite Administrative Fee 10.00 $10.0 0 Callahan. Nicholas P. Audiometry W /Discrimination $65.00 $65.00 Vision Titmus $15.00 $15.0c Offsite Administrative Fee $10.00 $10.0 0 Case. Darcy L. Audiomet W /Discrimination $65.00 $65.00 Vision Titmus $15.00 $15.00 Offsite Administrative Fee $10.00 $10.00 Collins. Mindy L. Audiometry W /Discrimination $65.00 $65.00 Vision Titmus $15.00 $15. Offsite Administrative Fee $10.00 $10.00 Heinzman. Jr., David M. Audiometry W /Discrimination 65.00 $65.00 Vision Titmus $15.00 $15.00 Offsite Administrative Fee $10,00 $10,00 Polovick, Tara L. Audiometry W /Discrimination $65.00 $65.00 Vision Titmus $15,00 $15.O 0 Offsite Administrative Fee 10:00 10.00 Reed Michele R. Audiomet W /Discrimination $65.00 65.00 Vision Titmus $15.00 $15,00 Offsite Administrative Fee $10. 00 $10.0 0 Stilts Dennis Audiomet W /Discrimination $65.00 $65.0 0 Vision Titmus 1 $15.0 Offsite Administrative Fee $10.00 $10.00 Sutton Karen L. Audiometry W /Discrimination $65.00 $65.00 Vision Titmus $15.00 $15.00 Offsite Administrative Fee $10.00 10.00 T ier Janice Y. Audiometry W /Discrimination $65.00 65.00 Vision Titmus $15.00 15.00 Offsite Administrative Fee $10. DO $10.00 10121108 Hines. Glenn W. Audiomet W /Discrimination $65,00 $65.00 Vision Titmus $15.00 $15.00 Offsite Administrative Fee $10.00 $10.0 0 Jokantas John M. Audiometry W Dis rimin tin $65,00 $65, Vision Titmus $15.OQ 15.0 Offsite Administrative Fee $10.00 $10.00 Mc Gee. William D. Audiomet W /Discrimination $65.00 $65.00 Vision Titmus 15.00 $15.00 Offsite Administrative Fee 10.00 $10.00 Underwood. Amv M. Audiometry W /Discrimination $65,00 $65.00 Vision Titmus $15.00 15.00 Offsite Administrative Fee $10.00. $10.00 Walton Marcia K. Audiometry W /Discrimination $65.00 $65,00 Vision Titmus $15.00 $15.00 Offsite Administrative Fee $10.00 $10.0 0 Wolfe Lin L. Audiomet W /Discrimination 65.0D $65.00 INVOICE Public Safety Medical Services 324 E. New York Street Suite 300 m Indianapolis, IN 46204 Carmel Clay Communications 1 CARMCOM Terms F 31 First Avenue NW Invoice Date 11/03/2008 to Y! Carmel, IN 46032 Invoice 00 -10112 'Date" Employee Description Amount: Balance Due Vision Titmus $15.00 $15.00 Offsite Administrative Fee $10,00 sio.001 W ler Kay E. Audiometry WlDiscrimination $65.00 $65.00 Vision Ti 1 15. Offsite Administrative Fee $10.00 $10.00 10/22/08 Amone• Janet R. Audiometry WlDiscrimination $65.00 $65.00 Vision Titmus $15.00 $15.00 Offsite Administrative Fee $10.00 $10.00 Collins Ashley M. Audiomet W /Discrimination 65.00 $65.00 Vision Titmus $15.00 $15,0 0 Offsite Administrative Fee $10.00 $10.00 F Sher D. Audiometry W /Discrimination 65.00 $65.00 Vision Titmus $15.00 $15.00 Offsite Administrative Fee $10.00 $10.00 Gordon Pegay D. Audiometry W /Uscrimination $65.00 $65.0 0 Vision Titmus $15.00 15.00 Offsite Administrative Fee $10.00 $1100 Luckoski, Todd C. Audiometry W /Discrimination $65.00 $65.00 Vision Titmus $15.00 $15.00 Offsite Administrative Fee $10.00 $10.00 Meyer. Amanda M. Audiomet W /Discrimination $65,00 $65.0 0 Vision Titmus $15.00 $15,0 0 Offsite Administrative Fee $10,00 sio.001 Smith Brian M. Audiometry WlDiscrimination $65.00 $65.00 Vision Titmus $15,00 $15.0 0 Offsite Administrative Fee $10.00 $10.0 0 Wenger, Audiometry W /Discrimination $65.00 65.00 Vision Titmus $15.00 $15.00 Offsite Administrative Fee $10.00 $10.00 ,Totat Charges ;Total` Payments ,'&'Balance,Due $0:00 ;$2250:00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date. I VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Ste 300 Indianapolis, In 46204 $2,250.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Clay Communications PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1115 00 -10112 43- 509.00 $138.00 I hereby certify that the attached invoice(s), or 16554 00 -10112 43- 509.00 $2,112.00 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 Monday, November 17, 2008 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)) 11/03/08 00 -10112 $138.00 11/03/08 00 -10112 $2,112.00 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 INVOICE o' Public Safety Medical Services 324 E. New York Street r: Suite 300 Indianapolis, IN 46204 O Carmel Police Department I CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 11112I2008 m Invoice 9 00 -10163 Date Employee: ,s�� t :''DescriptEon'� :Amount `Balarice Duey 09/16/08 Spillman, R, (Scott) S. Exec 1 (Wellness) Offsite $61.00 $61.00 HIV 1 2 $0.00 $0.00 Quantiferon Tb Gold $50.00 $50.00 11103108 Kinkade. Matthew P. Exec 1 Wellness 61.00 $61.0 0 HIV 1 2 $0.00 $0.00 Quantiferon Tb Gold $50.00 $50.0 0 Leach, Aaron M. Exec 1 Wellness 61.00 $61.00 HIV 1 2 $0.00 $0.00 Q uantiferon Tb Gold 50.00 $50.0 0 Snow Donald C. Exec 1 Wellness 61.00 61.00 HIV 1 .00 .0 PSA $36.00 $36.00 Total�Cti'arges $430:00 2 Total Payments &1Balarice`Due $0i00 "$430:00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date INVOICE F Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 o`. Carmel Fire Department I CARMEFD Terms 2 Civic Square Invoice Date 11/18/2008 m Carmel, IN 46032 Invoice 00 -10221 Date. Employee Description Amount; 'Balance.Due 11111/08 Marcum, Brad lev D. Ph sical Level 31 $232.00 $232.00 OnMed Program $10.00 $10,00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen f Pk $55.00 $55,0 0 11112/08 Johnson. Jeremy S. Phvsical Level 3 $232.00 $232.00 OnMed Program 10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $5500 "ToteLGhar es $924':00. a 7otal:Payments Ba lance 'Due .:$0:00. $924:00. Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date INVOICE -o Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 Q Carmel Police Department 1 CARMEPO Terms 3 Civic Square Carmel, IN 46032 Invoice Date 1111812008 Invoice 00 -10222 Date° Employee. Description Amouht 3alance Due; 11/10/08 Broadnax. Matthew L. Exec 1 (Wellness) Offsite $61.00 $61.00 Quantiferon Tb Gold $50.00 $50.0 0 Clark Sr_ Todd C. Exec 1 Wellness Offsite $61.00 $61.00 HIV 1 &2 0.00 $0.00 Quantiferon Tb Gold $50.00 $50.00 Graham, Brace A. Exec 1 Wellness Offsite $61.00 $61,0 0 Quantiferon Tb Gold $50.00 $50.00 Green Timothy J. 10 Cities $234,00 $234.00 OnMed Program $10.00 $10.0 0 Treadmill (PFE) $165.00 $165.00 BIA (Bio-Eleg Im ed Anal 14.0 114. Flexibi[itv Check $7.00 $7.00 Waist/Hi Ratio $0.00 $0.00 Malloy, Katherine E. 10 Cities $234.00 $234.00 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $7.00 $7.00 Waist/Hi Ratio $0.00 $0.00 Molter. Matthew S. 10 Cities $234.00 $234.00 OnMed Pro ram $10.00 $10.0 0 Treadmill PFE 165.00 $165.00 BIA (Bic-Elec Im ed Anal 14.0 $14.0 0 Flexibility Check $7.00 $7.00 Waist/Hi Ratio $0.00 $0.00 Myers Bradv R. Exec 1 (Wellness) Offsite 61.00 $61,0 0 KV 1 2 $0.00 $0.00 Quantiferon Tb Gold $50.00 $50.00 Spillman. R. Scott S. 10 Cities $234.00 $234.00 OnMed Program 10.00 10.00 Treadmill (PFE) $165.00 $165.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $7,00 $7,00 Waistlft Ratio 0.0 Stein Amy J. Exec 1 Wellness Offsite $61.00 $61.00 Quantiferon Tb Gold $50.00- $50:00 11/11/08 Brad Sean P. 10 Cities $234.00 $234.00 OnMed Program $10.00 $10.00 Treadmill (PFE $165.00 $165.00 BIA Sio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $7.00 $7.00 Waist/Hi Ratio $0.00 $0.00 Dixon Micheal R. 10 Cities $234.00 $234.00 OnMed Program $10.00 $10.0 0 Treadmill PFE 165.00 $165.00 BIA Bio -Elec Im ed Anal 14.00 $14,0 0 INVOICE 0. Public Safety Medical Services 324 E. New York Street 'E? Suite 300 Indianapolis, IN 46204 oh Carmel Police Department/ CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11/18/2008 Invoice 00 -10222 Date `r Employee Description Amount :.:Balance.Due Flexibility Check $7.00 $7.00 Waist/Hi Ratio $0.00 $0,001 Harris Sarah E. 10 Cities $234.00 $234.001 nM d Program $10.00 10.00 Treadmill (PFE) $165.00 $165.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibility Check $7.00 $7.00 Waist/Hi Ratio $0.00 $0.00 Hedrick Brad A. No -Show Fee $0.00 $0.00 Mvers. BradV R. 10 Cities $234.00 $234.00 OnMed Program $10.00 $10.00 Treadmill (PPE) $165.00 $165.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $7.00 $7.00 Waist/Hi Ratio 0.00 $0.00 Sedberry. Jeffrey T. 10 Cities $234.00 $234.00 OnMed Pro ram $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 BIA Bio -Elec Im ed Anal) $14.00 $14.00 Flexibility Check $7,00 $7.00 Waist/Hi Ratio $0.00 $0.00 Snow. Donald C. No -Show Fee (Familv Emer enc 0.00 $0.00 White. Kari E. 10 Cities $234.00 $234.00 OnMed Pro ram $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibilitv Check $7,00 $7.00 Waist/Hi Ratio $U0 $0.00 i Total Charges 14,855.00 Total Payments Balance'Due $0.00 $4,855.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federa€ Employer Identification Number is 35- 2079797 date 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 Public Safety Medical Services Purchase Order No. 324 E. 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)) 11/12/08 10163 payment for officer physicals 430.00 11/18/08 10221 pavment for officer physicals 924.00 11/18/03 10222 payment for officer physicals 4,855.00 Total 6,209.00 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 i VOUCHER NO. WARRANT NO. ALLOWED 20 P Uh.lic Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 6,209.00 ON ACCOUNT OF APPROPRIATION FOR p olic e genera fund Board Members Po# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 10163 407 -01 430":00 bill(s) is (are) true and correct and that the 1110 10221 407 -01 924.00 materials or services itemized thereon for 1110 10222 407 -01 4,855.00 which charge is made were ordered and received except November 19 20 08 &,.A.-,91 Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund