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Home My WebLink About163361 09/03/2008 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: $34,513.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 163361 CHECK DATE: 9/3/2008 DEPARTMEN ACCOUNT PO NUMBE INV NU MBER A MOUNT DES ,_1120 4340701 9715 17,404.00 MEDICAL EXAM FEES 1120 4340701 9766 16,254.00 MEDICAL EXAM FEES 1110 4340701 9767 855.00 MEDICAL EXAM FEES I J INVOICE o Public Safety Medical Services 324 E. New York Street .r E Suite 300 sY Indianapolis, IN 46204 o Carmel Fire Department I CARMEFD Terms 2 Civic Square Invoice Date 08/19/2008 Carmel, IN 46032 Invoice 00 -09715 Date ;Employee Description Amount.. tBalance Due. 08/11/08 Alverson, Jonathon L. Physical Level 3 $232.00 $232.00 OnMed Program $10.00 $10.0 0 Treadmill (PFE) $165.00 $165.0 0 Funct Move Screen Pk 55.00 $55.0 0 Brandt. Gary 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 done In Error 0.00 0.00 Frye, Steven R. No -Show Fee 40.00 $40.00 Love, Jose Josenh B. Physical (Level $232.00 $232.00 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen (Pk $55.00 $55.00 Marcum Bradley D. No -Show Fee $0.00 $0.00 Plumer, Charles J. 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 Reecer. Jason L. Chest PA/LAT $60.00 $60.00 Physical (Level 3) 232.00 $232.00 OnMed Program $10,00 $10.0 0 Treadmill (PFE) $1 5 0 $165,0 Funct Move Screen Pk $55.00 $55.00 Steurv, Kent C. Physical Level 3? $232.00 $232.00 OnMed Program $10.00 $10.0 0 Funct Move Screen Pk No TM 55.00 $55.00 Toney, James D. 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 Weaver Virgil L. No -Show Fee $40.00 $40.00 08/12/08 Contino David M. Physical Level 3 232.00 $232.00 OnMed Proararn $10.00 $10. Treadmi PF 1 1 Funct Move Screen Pk $55.00 $55.00 Davis James M. 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 Holden Adam D. 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 Howard Wendell E. Ph sica) fLevel 3 232.00 $232.00 OnMed Program sio.0o $10,0 0 INVOICE o Public Safety Medical Services 324 E. New York Street as Suite 300 Indianapolis, IN 46204 o,a Carmel Fire Department 1 CARMEFD Terms t- 2 Civic Square Invoice Date 08119/2008 m Carmel, IN 46032 Invoice 00 -09715 Date Employee ....!Description Amount Balance Due Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55.00 Lux Michael T. Physical Level 3 232.00 $232,00 Q n Prgargm 1 $1 0,001 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Stindle, Kevin P. Physical Level 3) $232.00 $232.00 OnMed Program $40.00 '$10.00 Chest PA/LAT $60.00 60.00 Treadmill (PFE) $165.00 $165.0o Funct Move Screen Pk 5500 $55.00 Workman William J. Ph sical 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 $55.0 0 Zeller Michael J. 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 08/13/08 Benbow, Kip S. Physical Level 3 $232.00 $232.00 OnMed Program sio.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 Dufek Gary J. Physical (Level 3) 232.00 $232.00 OnMed Program 1000 slo.00 Treadmill (PFE) $165.00 $165,00 Funct Move Screen Pk a) $55.00 $55,0 Kilburn, Ro er L. 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 Hepatitis B Vaccination #3 70.00 $7G,O 0 In ection Fee $10,00 $10.0 0 Martin David D. Physical Level 3 232.00 1232.0 0 OnMed Program $10,00 $10.0 0 Treadmill (PFE) $165.00 $165,00 Funct Move Screen Pk 55.00 $55,0 0 Starr, r h i l (Level $232.00 2. OnMed Pro r m 10.0 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Stroup, 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 $55.0 0 Chest PA/LAT $60.00 $60.00 INVOICE :0 Public Safety Medical Services 324 E. New York Street E. Suite 300 Indianapolis, IN 46204 o` Carmel Fire Department 1 CARMEFD Terms 2 Civic Square Invoice Date 08/9912008 Carmel, IN 46032 Invoice 00-09715 Date Employee Description: Amount Balance Due: Wendzel, Jason 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 $55.0 0 Chest PA/LAT $60.00 $60.00 Whitaker Charles 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 $55,0 0 08/14/08 Anderson D. Cory Physical Level 3 232.00 $232.00 nM d Program 10 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Essex. Cory 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 $55.0 0 Chest PA/LAT $60.00 $60.0 0 Foster James P. 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 Gd es &frey A. Physical eve $2 22,00 $23200 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen (Pkql $55.00 $55.0 0 Hoyt. Gary 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 Reeves Ste hen J. Physical Level 3 232.00 $232.00 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk a) $55.00 $55.0 Revnolds. Shawn J. Physical eve! 3) $232.00 $232. OnMed Pro ram $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 W ant Andrew 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 08/15/08 Cox Justin M. Physical Level 3 232.00 $232.00 OnMed Pro ram $10.00 $10.00 Treadmll (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55.00 INVOICE Rio Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 08N912008 Invoice 00 -09715 "Date EmpEoyee :Description .'Amount Balance Due' Cummins. Frank C. Phy sical Level 3 232.00 $232.00 OnMed Pro ram $10.00 10.00 Chest PA/LAT 60.00 $60.0 0 Treadmill (PFE) $1 0 $165.0 0 Funct Move Screen Pk $55.00 $55.00 Drake Carl 0. Physical (Level 3) $232.00 $232.00 OnMed Program $10.00 $10.00 Fund Move Screen Pk No TM $55.00 $55.0 0 Gipson Bruce E. Phy sical Level 3 $232.00 $232.0 0 OnMed Program $10.00 $10.0 0 Chest PAILAT $60.00 $60.0 0 Treadmill PFE 165.00 $165.00 Fund Move Screen Pk 55.00 $55.00 Horner David W. Physical Level 3 232.00 $232.00 Fund Move Screen Pk 55.0 $55.0 0 Treadmill (PFE) $165.00 $165.00 OnMed Program $10.00 $10.00 Moriarty. John F. 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 Total- Charges $17i404.00' BeIanc"D' Total "Peyii�ents';8; ue $0;&d i$17;404:00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 INVOICE Public Safety Medical Services 324 E. New York Street .,E Suite 300 ,W Indianapolis, IN 46204 o Carmel Fire Department CARMEFD Terms 2 Civic Square Invoice Date 08/2612008 m. Carmel, IN 46032 Invoice 00 -09766 Date Employee Description Amount Balance,Due' 08/18/08 Gu el, Mark E. 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.QQ Waboush David G. No -Show Fee 0.00 sc.00 Lenze Theodore A. Physical Level 3 232.00 $232.00 OnMed Program $10.G0 sio.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 $55.0 0 Miller Scott G. Ph sical Level 3 232.00 $232.00 OnMed ro ram $10.00 $10.0 0 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Chest PA/LAT (N/C) $0.00 $0.00 Platt Jace P. 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 Reeves, Neil P. 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 5 .00 Voskuhl. Mark J. Physical Level 32,00 f $232.0 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 Walker Christo her 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 $55.0 0 Webb Gregory A. Physical (Level 3) $232.00 $232.00 OnMed Program $10,00 $10.0 0 Tr m ll (PFE) $1 5. 0 1 $165.00 Funct M ve Screen Pk .00 08/19108 Buttler, James N, Physical Level 3 $232.00 $232.00 OnMed Program $10.00 $10.00 Chest PA/LAT $0.00 $0.00 Treadmill (PFE $165.00 $165.00 Funct Move Screen Pk $55.00 $55,0 0 Gehlbach, Marc 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 Giles. William G. Physical Level 3 232.00 232.00 OnMed Pro ram $10.00 10.00 r4 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 a: Indianapolis, IN 46204 Carmel Fire Department l CARMEFD 2 Civic Square Terms Carmel, IN 46032 invoice Date 08/2612008 Invoice 00 -09766 ':::Date 'Ernployee Description: ?Amount Bdlarice -Due: Chest PA/LAT $60,00 $60.00 Treadmill (PFE $165.00 S165AX Funct Move Screen Pk 55.00 $55.0 0 Mar oon, rnie R. Physical( eve! 23 .0 OnMed Program $10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Peterson. Vernon A. Ph sicaf 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 Utzig, Chad M. Physical Level 3 232.00 232.00 OnMed Program $10.00 $10.00 Chest PA/LAT $60.00 $60.0 0 Treadmill (PFE) $165.00 $165.00 Fund Move Screen (PkM 155.00 $55,0 0 Utzi Todd T. 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 Weaver. Virgil L. Physical Level 3 232.00 $232.00 OnMed Program $10.00 $10.00 Chest PA/LAT 60.00 $60.00 Treadmill (PFE) $165.00 $155.00 Fund Move Screen Pk 55.00 $55.0 0 08/20/08 Ca shave Jeffrey A. No -Show Fee 0.00 $0.00 Edwards Steven L. Physical Level 3 232.00 $232.0 0 OnMed Pro ram $10.00 $10.0 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Hulett Mark A. No-Show Fee $0.00 $0.00 Kelsheimer. Troy W. Ph sicaf (Level 3) 232.00 $232.00 OnMed Program 10.00 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk 55.00 555.0 0 Kinney, Jared N. Physical Level 3 232.00 $232.00 OnMed Program $10.00 $10.0 0 Treadmill (PFE) $165.00 165.00 Fu= v Screen Pk $55.0 C hest PA/LAT $60.00 $50.QQ Marsh, Michael A. Physical Level 3 $232.00 $232.00 OnMed Program $1100 $10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Paddock. Ronald D. Physical Level 3 $232.00 $232 -00 OnMed Program $10.00 $10.00 Treadmill (PFE $16500 3165.00 INVOICE o Public Safety Medical Services 324 E. New York Street Suite 300 Indianapolis, IN 46204 Carmel Fire Department CARMEFD Terms 2 Civic Square invoice Date 08/26/2008 m. Carmel, IN 46032 Invoice 00 -09766 Date Employee' `:Description Amount" Balance Due Funct Move Screen Pk $55.00 $55.00 VanVoorst. Robert J. Ph sical 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 08121108 Conner. Timothy L. 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 Dorsch James E. Ph sical Level 3 232.00 $232.00 OnMed Pr m 10.0 $10.0 Treadmill (PFE) $165.00 $165.00 Fund Move Screen Pk $55.00 $55.00 Holubik Steven 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 Mitchell. James C. 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 $55.0 0 Sharp, Adam C. Physical Level 3 232.00 $232.00 O nMed Program 10.0 10. 0 Treadmill (PFE $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Smith, Brian E. 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 $55.0 0 Vallone. Frank Physical Level 3 232.00 $232.00 OnMed Program $10.clo $10.0 0 Treadmill (PFE) $165.00 $1165.00 Funct Move Screen Pk 55.00 $55.00 08/ 22/08 Brant. Kenneth E, Phvaicad eve! 232.00 $232.0 OnMed Program 1 10.00 Treadmill (PFE) $165.00 $165.00 Funct Move Screen Pk $55.00 $55.00 Tetanus Immunization $20.00 $20.00 hection Fee $10.00 $10.00 Ca Shaw, Jeffrey A. Ph sical Level 3 $232.00 $232.00 OnMed Program 10.00 $10.00 Chest PA/LAT $60.00 $60.00 Treadmill (PFE) $165.00 $165,00 Fund Move Screen Pk 55.00 $55.00 Frye, Steven R. Treadmill (PFE $165.00 $165.00 Funct Move Screen Pk 55.00 55.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 W' Indianapolis, IN 46204 O, Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 0812612008 m Invoice 00 -09766 Date Employee Description Amount Balance. Due: Phy sical Level 3 232.00 $232.00 OnMed Program $10,00 $10,OC Chest PA/LAT $60.00 $60,0 0 H M Physical vl 3) $232.00 $232.D 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 Knott Bruce 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 PSA $36.00 $36,00 Total charges $16;254:Op Total Payments& Balance'Due $0.00' $16,254.00 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 $33,658.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 9766 43- 407.01 $16,254.00 1 hereby certify that the attached invoice(s), or 1120 9715 43- 407.01 $17,404.00 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 r zd v V .A �4 Title Cost distribution ledger classification if paid motor vehicle highway fund Prescribed by Stale 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)) 9766 Physicals $16,254.00 9715 Physicals FF's $17,404.00 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 o Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 0 Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 08/26/2008 Invoice 00 -09767 :.:Date Employee Description Amount Balance Due: 08118/08 Grose. James 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 McInlyre, Trent A. 10 Cities 1234,00 $234.0 0 OnMed Pro ram $10.00 $10.0 0 Treadmill (PFE) $165.00 $165.00 Body Fat Check Bod Pod $23.00 S23,0 0 Flexibilitv Check S7,00 7.00 Waist/Hi Waist/Hiu Ratio A 0.0 Total.Charges._> $855;00: Total Payments' &'Balance'Due '$0:04 1 -$855.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 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 E. New YOrk Street, Suit 300 Terms Indianapolis, IN 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 8/26/08 9767 payment for officer physicals 855.00 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 855.00 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 1110 9767 407 -01 855.00 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 AUgust 28 2008 Signature Chief of'POlice Cost distribution ledger classification if Title claim paid motor vehicle highway fund