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163916 09/17/2008 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of. 1 t` ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES f CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $17,177.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 163916 CHECK DATE: 9/17/2008 DE PARTMENT ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION 1120 4340701 9797 15,324.00 MEDICAL EXAM FEES 1110 4340701 9798 832.00 MEDICAL EXAM FEES 1110 4340701 9828 1,021.00 MEDICAL EXAM FEES INVOICE o' Public Safety Medical Services 324 E. New York Street. Suite 300 lY< Indianapolis, IN 46204 Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 09!03!2008 mE Invoice 00 -09797 'spate rrtEmployee. Description Amount Balance:Due' 08/25/08 Carter Gary L. Physical Level 3 $232.00 $232.00 OnMed Program $10.00 $10.0 0 Chest PA/LAT $60.00 $60.0 0 Treadmill (PFE 165.00 $165.00 Funct Move Screen Pk 55.00 $55.00 Condra K ie E. Physical Level 3 232.00 $232.00 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.0 0 Funct Move Screen Pk 55.00 55.00 Crane Barry L. Physical (Level 3 232.00 $232.00 OaM Pr oararn $10.00 S1 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.0 0 Deitsch. Marc W. No -Show Fee $0.00 $0.0 6 Payne, Thomas C. Physical Level 3 $232.00 $232.00 OnMed Program $10,00 $10.0 0 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55,0 0 Spelbring. James E. Physical Level 3 232.00 $232.0 0 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55.0 Q Tierney. Scott A. No-Show F Viehe Richard E. Physical Level 3 $232.00 $232.00 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 165.00 Funct Move Screen Pk 55.00 $55.00 Weddin ton Kurt L. No -Show Fee 10.00 $0.0 0 08/26/08 Harrington, Adam C. Physical Level 3 232.00 $232.00 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55.00 Chest PA/LAT $60.00 $60.0 0 Hffm (Lev 3 OnMed P 1 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Martin Richard A. Physical Level 3 232.00 $232.00 OnMed Program $10.00 $10.0 0 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55.00 Mead Jr. Donald R. Physical Level 3 232.00 $232,00 OnMed Program $10.00 $10,0 0 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 55.00 Osborne Scott K. Ph sical Level 3 232.00 232.00 INVOICE o Public Safety Medical Services 324 E. New York Street Suite 300 d ,mss` Indianapolis, IN 46204 o R Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 09/03/2008 Invoice 00 -09797 Employee Description A' .,::Amount ,,.`.Balance, Due OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55.00 Robinson, Mitchell h s" I (Level OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Schcoier, "Dustin D. Physical Level $232.00 S232.GC OnMed Program $10.00 $10.0 0 Treadmill (PFE 1165.00 $165.0 0 Funct Move Screen Pk 55.00 $55.0 0 Young Alan R. Physical Level 3 232.00 232.00 OnMed Program $10.00 $10.00 Treadmill (PFE $165.00 $165.00 Funct Move Screen Pk 55.00 $55.00 08/27108 Deitsch Marc W. Physical (Level 3 232.00 $232.00 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Freer Keith T. Physical Level 3 $232.00 $232.00 OnMed Program $10.00 $10,0 0 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55.0 0 Frost Bruce S. Physical Level 3 232.00 $232.00 OnMed Program $10.00 $10.00 Tr eadmill (PFE) $1 0 $165.00 Fun t Move Screen Pk 55.00 $55.00 QbQ t- PAILAT Haboush, David G. Physical Level 3 $232.00 $232.00 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55.0 0 Kehl William D. Physical Level 3 232.00 $232.D0 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 55 "00 Steele Jeffrey A. Physical Level 3 232.00 $232.00 OnMed Pro ram 10.00 $10,00 Treadmill (PFE) $1 1 Funct Move r P 00 Tierney, Scott A, Physical Level 3 $232.00 $232.00 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 1 $55.0 Weddin ton Kurt L. Physical Level 3 232.00 $2,32.D0 OnMed Program $10.00 $10.00 Treadmill (PFE) 1 $165.00 $165.o 0 INVOICE or' Public Safety Medical Services 324 E. New York Street Suite 300 Indianapolis, IN 46204 Carmel Fire Department l CARMEFD o Terms 2 Civic Square m�k Carmel, IN 46032 Invoice Date 09103!2008 Invoice 00 -09797 Date Employee• ryv Aescriptidn;`: Amount "Balance:Due- Funct Move Screen Pk $55.00 $55.00 08/28/08 Collins. Tony A. Physical Level 3 232.00 $232.00 OnMed Program 10.00 $10,0 0 Chest PAILAT $60.00 $60.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen (Pkql $55.00 $55.00 Fa in Timothy D. Physical Level 3 232.00 $232.00 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55.00 Chest PA/LAT $60.00 PA/LA 60. Frenzel, Edc C. Physical Level 3 $232.00 $232.00 OnMed Program $10.00 10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Keaton Anthony R. Physical (Level 3) 232.00 $232,00 OnMed Program 10.00 $10.00 Treadmill (PFE $165.00 $165.00 Funct Move Screen Pk 55.00 $55.0 0 Oran a Douglas D. Physical Level 3 232.00 23200 OnMed Pro ram $10.00 $10.00 Treadmill (PFE) S165.00 $165.00 Funct Mo Chest PA/LAT $60.00 $60.00 Phillips, Craig M. Physical Level 3 232.00 $232.00 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Fund Move Screen Pk 55.00 $55.00 Ryan, Christopher D. Physical Level 3 232.00 $232.0 0 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55.00 Chest PA/LAT $60.00 $60.00 A ndrew (Lev OnMed Pr 1 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Chest PA/LAT $60.00 $60.00 08/29/08 Ellison, Christopher M. Physical Level 3 $232.00 $232.00 OnMed Pro ram $10.00 10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55.00 Small Thomas D. Physical Level 3 232.00 $232.00 OnMed Pro ram $10.00 $10.00 Chest PAlLAT $60.00 $60.0 0 Treadmill (PFE) $165A0 $165.00 INVOICE 56� Public Safety Medical Services 324 E. New York Street Suite 300 °1;j Indianapolis, IN 46204 o J Carmel Fire Department CARMEFD Fl 2 Civic Square Terms Carmel, IN 46032 Invoice Date 09/0312008 Invoice 00 -09797 Date° Employees Descriptions "3 .'Amount `Baia ce Due Fund Move Screen (Pkg) $55.00 $55.00 :Total Charges 15,324'00 otaP T Payments' &`Ba lance 'Due -$0:00 x$15,324:00 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 $15,324.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT##/TITLE AMOUNT Board Members 1120 9797 43- 407.01 $15,324.00 I 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 1-J Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts Ciy 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)) 9797 Exams $15,324.00 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 Public Safety Medical Services w 324 E. New York Street E, Suite 300 Indianapolis, IN 46204 s` Carmel Police Department CARMEPD p 3 Civic Square Terms Carmel, IN 46032 Invoice Date 09/03/2008 m Invoice 00 -09798 :..Dater; :Employee ::'Description ?aAmount. Balance-Due.' 08/27/08 Harris Robert P. 10 Cities $234.00 $234.00 OnMed Program $10.00 $10.0 0 Treadmill (PFE) $165.00 $165.00 Flexibility Check $7.00 $7.00 Waist/Hi Ratio $0.00 $0.00 Locke Robert E. 10 Cities $234.00 $234.00 OnMed Program $10.00 $10.0 0 Treadmill (PFE) $165.00 $165.00 Flexibility Check $7.00 $7.00 Waist/Hi Ratio $0.00 0.00 M Total,CFiarges 5$832t00 &`balance Due $0:00. Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 .14. -�z INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 H Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 09/10/2008 m Invoice 00 -09828 Date Employee Description Amount Balance Due 09/03/08 Collins. Larry J. Exec 1 (Wellness) $61.00 $61.00 HIV 1 2 $0.00 $0.00 Quantiferon Tb Gold $50.00 $50.00 09/04/08 Driver. Charles 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 Hedrick Brad A. Exec 1 Wellness Offsite $61.00 $61.0 0 HIV 1 &2 $0.00 $0.00 Q uantiferon Tb Gold $50.00 $50.0 0 Horner. Jeffrey J. Exec 1 Wellness Offsite $61.00 $61.00 HIV 1 2 $0.00 $0. Quantiferon Tb Gold $50.00 $50.00 Miller, Gregory H. Quantiferon Tb Gold $50.00 $50.00 Troyer, Darin M. Exec 1 (Wellness) Offsite $61.00 $61.00 HIV 1 2 $0.00 $0.00 Quantiferon Tb Gold $50.00 $50.00 09/05/08 Schoeff, Jr.. Donald D. 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 Total Charges $1,021.00 Total Payments Balance Due $0:00 $1,021.00 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 Public Safety Medical S ervice s Purchase Order No. 324 E. New York Street, Suit 30C Terms Indianplis, IN 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 9/3/08 9789 payment for officer physicals 832.00 q 9/10/08 payment for officer physicals 1,021.00 Total 1,854.00 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 Puilic Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 1,854.00 ON ACCOUNT OF APPROPRIATION FOR police general fund Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 9798 407 -01 832.00 bill(s) is (are) true and correct and that the 1110 9828 407 -01 1,021.00 materials or services itemized thereon for which charge is made were ordered and received except September 11 20 08 Signature Chiefof POlice Cost distribution ledger classification if Title claim paid motor vehicle highway fund