165926 11/12/2008 a- CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
0 CHECK AMOUNT: $4,686.00
i`• CARMEL, INDIANA 46032 324 E NEW YORK S7 SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 165926
rop c°
CHECK DATE: 11112/2008
DEPARTMENT ACCOU PO NUMBER INVOI NUMBER AMOUNT DESCRIPTION
1120 4340701: 10049 60.00 MEDICAL EXAM FEES
1110 4340701 10050 3,415.,00 MEDICAL EXAM FEES
1120 4340701 10113 245.00 MEDICAL EXAM FEES
1110 4340701 10114 966.00 MEDICAL. EXAM FEES
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1 INVOICE
o Public Safety Medical Services
324 E. New York Street
'E. Suite 300
0
04 Indianapolis, IN 46204
o Carmel Police Department I CARMEPD
3 Civic Square Terms
Carmel, IN 45032 Invoice Date 11/0372008
m Invoice 00 -10114
Date �,'EmpEoyee Description1Amount ,�'rBalance"Due
10/20/08 Jellison, Ryan D. Exec 1 Wellness $61.00 $61.00
Quantiferon Tb Gold $50.00 $50.00
10/21108 Carey. Luckie A. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
Body Fat Check Bod Pad $23.00 $23.0 0
Flexibility Check $7.00 7.00
Waist/Hi Ratio $0.00 $0.00
10127108 Case Todd L. 10 Cities $234.00 $234.00
OnMed Pro ram $10,00 $10.00
Treadmill (PFE $1 0 16
Flexibili Check $7.00 $7.00
Waist/Hi Ratio $0.00 $0.00
es $966:00
Tatal'Charg
T
r "otalPayments "Balahce'Due $0.00. ~$966.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
f INVOICE
o Public Safety Medical Services
324 E. New York Street
:r
Suite 300
Indianapolis, IN 46204
0 Police Department/ CARMEPD
F- 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 10/28/2008
03. Invoice 00 -10050
°Date ;Employee '•.Description %Amount Balance Due
10113108 Troyer, Dann M, 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
Flexibility Check $7.00 $7.00
Waist/Hi Ratio $0.00 $0.00
10/14/08 Lona. Scott D. 10 Cities $234.00 $234.0 0
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 S165.Do
Flexibility Check $7.00 $7,0 0
Waist/Hi Ratio $0.00 $0.00
10115/08 Me r Ryan J. HIV $0.00 $0,
Quantiferon Tb Gold $50.00 $50.00
Exec 1 Wellness Offsite $61.00 $61.00
Pads, Mark J. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 $165.00
BodV Fat Check Bod Pod $23.00 $23.0 0
Flexibilily Check $7.00 7.00
Waistlft Ratio $0.00 $0.00
OnMed Program $10.00 $10.0 0
Pilkin ton Scott 10 Cities 234:00 $234.00
OnMed Pro ram $10.00 $10.0 0
Treadmill PFE 165.00 $165.0 0
Flexibility Check $7.00 $7.
Waist/Hi Ratio $0.00 $0.00
Rush, Michael T. Exec 1 Wellness Offsite $61.00 $61.00
HIV 1 2 $0.00 $0.00
Quantiferon Tb Gold $50,00 $50.0 0
Sedberry. Jeffrey T. Exec 1 Wellness Offsite $61,00 61.00
HIV 1 &2 $0.00 $0.00
Quantiferon Tb Gold $50,00 $50.00
10/16/08 Bickel Joseph E. Exec 1 Wellness Offsite $61.00 $61,0 0
HIV 1 2 $0.00 $0.00
Quantiferon Tb Gold $50.00 $50.0 0
Bowman, Ggry A. (Wellness) Offsite 1 6
HIV
PSA $36.00 $36.00
Quantiferon Tb Gold $50.00 $50.00
Brady. Sean P. Quantiferon Tb Gold 50.00 $50.00
Exec 1 Wellness Offsite $61.00 $61.00
HIV 1 &2 $0.00 $0,00
Carey. Luckie A. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV 1 2 $0.00 $0,00
PSA $36.00 $36.00
Quantiferon Tb Gold $50.00 $50.0 0
Dixon Micheal R. Exec 1 Wellness Offsite $61.00 $61,0 0
HIV 1 2 $0.00 $0.00
'1
INVOICE
o Public Safety Medical Services
324 E. New York Street
E. Suite 300
Indianapolis, IN 46204
�o Carmel Police Department 1 CARMEPD
t 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 10/28/2008
Invoice 00 -10050
Date J. Employee Description Amount Balance Due
PSA 36.00 $36.00
Q uantiferon Tb Gold $50.00 $50.0 0
Fociarty, Michael D. Exec 1 Wellness Offsite $61,00 $61,0 0
HIV 1 IU SUM
PSA $36.00 $36.00
Quantiferon Tb Gold $50.00 $50.00
Green, Timothy J. Exec 1 Wellness Offsite $61.00 $61.00
HIV 1 &2 $0.00 $0.00
Quantiferon Tb Gold $50.00 $50.0 0
Haymaker. William E. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV 1 2 $0.00 $0.00
Quantiferon Tb Gold $50.00 $50.00
Howard Lana M. Exec 1 Wellness Offsite 61.00 $61,00
HIV 1 2 $0.00 $0.00
Q uantiferon Tb Gold 50.00 $50.00
Miller Adam C. Exec 1 Wellness Offsite $61.00 $61.00
HIV 1 &2 $0.00 $0.00
Quantiferon Tb Gold $50.00 $50.00
Mulligan, Laura J. Hepatitis B Vaccination #3 $70.00 $70.00
hection Fee $10.00 $10.00
10/17/08 Morrow, Scott A. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV 1 2 0.00 $0.00
P Total Charges $3,415;00
Total Payments Balance.Due $0.00
$3,415.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Balance due 15 days from invoice
date.
INVOICE
Public Safety Medical Services
324 E. New York Street
Suite 300
AD
Indianapolis, IN 46204
Q Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 4fiO32 Invoice Date 10/28/2008
m.. Invoice 00 -10049
'Date Employee' Description Amount;:.' Balancebue"
10/15/08 Gipson, Bruce E. Repeat Chest X -Ray $fio.00 $W1 00
TotalyCharges $60-.00
a ue $0:00 $B0t00�
TotaI Pa y ments�& Balance
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Balance due 15 days from invoice
date.
Prescnted 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))
11/3/08 10114 payment for officer physicals 966.00
10/ 8/08 10050 payment for officer physicals 3,415.00
Total 4,381.00
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.
ALLOWED 20
P ublic Safety Medical Services IN SUM OF
324 -E. New York Street, Suite 300
Indianapoils, IN 46204
4,381.00
ON ACCOUNT OF APPROPRIATION FOR
p olice general fund
Board Members
PO# or INVOICE NO. ACCT #[TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
114 407 -01 966.00 bill(s) is (are) true and correct and that the
1110 10050 407 -01 3,415.00 materials or services itemized thereon for
which charge is made were ordered and
received except
November 7 20 08
Signature
Chief of P01ice
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
i
INVOICE
;o Public Safety Medical Services
324 E. New York Street
-E Suite 300
m
V Indianapolis, IN 46204
o'. Carmel Fire Department! CARMEFD
2 Civic Square
Terms
Carmel, IN 46032 Invoice Date 11/03/2008
M Invoice 00 -10113
Date:,; Employee Description Amount Balance Due
10/24/08 Kilbum, Roger L. Fitness For Duty Level II $175.00 $175.00
Drug Screen 8 GC /MS WIMRO $70.00 $70.00
TotatCharg
es $245:00
Total•Pa ments &`Balance'D'ue $0:00 $245,00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$305.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO #1 Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1 120 10113 43- 407.01 $245.00 1 hereby certify that the attached invoice(s), or
1120 10049 43- 407.01 $60.00 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
NOY 2008
c
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))
10113 $245.00
10049 $60.00
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