162936 08/20/2008 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $18,244.00
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 162936
CHECK DATE: 8/20/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 9675 17,556.00 MEDICAL EXAM FEES
1110 4340701 9676 688.00 MEDICAL EXAM FEES
I
INVOICE
Public Safety Medical Services
324 E. New York Street
Suite 300
Indianapolis, IN 46204
o Carmel Police Department/ CARMEPD
1 -7 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 0811212008
-`oa Invoice 00 -09676
Date Employee Description. Amount Balance Due':
08/05/08 Bickel, Scott W. Quantiferon Tb Gold $50.00 $50.00
McIntyre, Trent A. Exec 1 Wellness Offsite $61.00 $61.00
HIV 1 2 $0.00 $0.00
Quantiferon Tb Gold $50.00 $50.00
Pilkin tan, Scott Exec 1 Wellness Offsite $61.00 $61.00
HIV 1 2 0.00 $0,00
Quantiferon Tb Gold $54:00 $50.00
08/07/08 Schmidt Brian E. 10 Cities $234.00 $234.0 0
OnMed Program $10,00 $10,0 0
Treadmill (PFE) 1 $165.00 $165.00
FLemiLility Check $7. $7,00
Waist/Hi Ratio $0.00 $0.00
'Total i h4rges '`x' :$688;00
Total;Payments &.Balance Dt e $0:00' $688:00;
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, Suite 300 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
8/12/08 9676 payment for officer physicals 688.00
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. Neia.rYork Street, Sutie 300
Indianapolis, IN 46204
688.00
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 9676 407 -01 688.00 bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
August 14 20Q8
Signature
Chief of P61ice
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
INVOICE
o Public Safety Medical Services
324 E. New York Street
Suite 300
LC' Indianapolis, IN 46204
Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/12/2008
Invoice 00 -09675
EmployeeDescnption,. Amount 'Balance Due
08104/08 Bartrorn Brad A. Physical Level 3 $232.00 $232.00
OnMed Pro ram $10.00 10.00
Castor Rick S. Physical Level 3 232.00 $232.00
Treadmill (PFE) $165.00 $165.00
Funct Move Screen Pk 55.00 $55.001
OnMed Program $10.00 $10,OC
Ha maker Samuel K. Physical Level 3 232.00 $232.0 0
OnMed Program $10.00 $1().D(
Treadmill (PFE) $165.00 165.00
Funct Move Screen Pk 55.00 $55.0 0
Hoo ver, Anthony B. Physical (Level $232.00
OnMed Program $10.00 $10.00
Treadmill (PFE $165.00 $165.00
Funct Move Screen Pk 55.00 $55.00
McNab John 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
Mead David L. Physical Level 3 232.00 $232.00
OnMed Program 10.00 $10.00
Treadmill (PFE) $165.00 $165.001
Funct Move Screen Pk 55.00 55.00
Mul ford, v' P v 0
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
Funct Move Screen (Pk g) $55.00 $55.00
Sombke Brad 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
08105108 Baskerville Anthony A. Physical (Level 3) 232.00 $232.00
OnMed Program $10.00 sio.00
Treadmill (PFE) $165.00 $165.00
Funct Move Screen Pk
B Orbie Physical (Lev $232,00 22.
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
Funct Move Screen Pk $55.00 $55.00
Callahan, Mark Treadmill (PFE) $165.00 $165.00
Funct Move Screen Pk 55.00 $55.00
Physical Level3 232.00 $232.00
OnMed Program $10.00 $10.0 0
Edwards Daniel E. Physical Level 3 232.00 $23
OnMed Program $10.00 $10.001
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
Suite 300
Indianapolis, IN 46204
Carmel Fire Department CARMEFD
Terms
,F 2 Civic Square
Carmel, IN 46032 Invoice Date 08/12/2008
Invoice 00 -09675
Date F:Employee` :.Description Amount Balance Due:.
Griffin Timothv M. Chest PA/LAT $60.00 $60.00
Physical (Level 3) 232.00 232.00
OnMed Pro ram $10.00 $10.00
Tr 1 55.QQ $1 65.00
Funct Move Screen Pk $55.00 $55.00
Hensley Robert 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 $55,001
Re ert. Ian 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 $55.00
Thompson James 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
08/06/08 1 Alien Brad 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
Bailey. Mark E. Physical Level 3 232.00 232.00
OnMed Program 110.00 10.00
Treadmill (PFE) $165.00 $165.00
Funct Move Screen Pk 55.00 55.00
Baskerville. Steven P. Physical Level 3 232.00 $232.00
OnMed Pro ram S10.00 10.00
BrisQo. Miglha Physical' Lev I 3) $232.0
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
Fund Move Screen Pk $55.00 $55.00
Chest PAJLAT $60.00 $60.0 0
DeCrastos Richard A. Physical (Level 3) 232.00 $232.00
OnMed Program $10,00 110.0 0
Treadmill (PFE) $165.00 $165.00
Funct Move Screen Pk 55.00 $55.00
DeLong. Michael T. Physical Level 3 232.00 $232.00
OnMed Program $10,00 $10.0 0
Treadmill (PFE) S1 fi .0 165.
Funct v Screen Pk $55.00
McNe ly Michael 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
Witsken. Steven J. Physical Level 3 232.00 232.00
OnMed Program 10.00 $10.00
Treadmill PFE 165.00 165.00
INVOICE
o Public Safety Medical Services
324 E. New York Street
Suite 300
Indianapolis, IN 46204
G Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/1212008
Invoice 00 -09675
Date Employee Description Amount <s Balance °Due
Funct Move Screen Pk $55.00 $55.00
08/07/08 Butts Joseph A. Ph sical Level 3 232.00 $232.00
OnMed Program 10.00 10.00
Treadmill (PFE) $165.00 $165.0 0
Fund Move Screen Pk 55.00 $55.001
Butts. Renee L. Physical Level 3 232.00 $232.00
OnMed Program $10,00 10.00
Treadmill PFE 165.00 $Ie5. 00
Funct Move Screen Pk 55.00 55.00
Crisler, Jchn H. Ph sica€ Level 3 232.00 $232.0 0
O nMed Proaram 510.00 11
Treadmill (PFE) $165.00 $165.00
Funct Move Screen Pk $55.00 $55.00
Fisher Gary L. Treadmill (PFE) $165.00 $165.00
Funct Move Screen Pk 55.00 $55.00
Physical Level 3 $232.00 $232.00
OnMed Pro ram 10100 $10.001
Nicle Wes W. Physical Level 3 232.00 $232.0 0
OnMed Program $10.00 $10.0 0
Treadmill (PFE $165.00 $165.0 0
Funct Move Screen Pk 55.00 $55.0 0
Chest PAILAT $60.00 $60.00
Robinson, Mark G. Physical via T>232.00 $2 32.00
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 $60.00
Rohr Christopher M. Physical Level 3 232.00 232.00
OnMed Program $10.00 $10.0 0
Treadmill (PFE) $165.00 $165.00
Fund Move Screen Pk 55.00 55.00
Chest PA/LAT $60.00 $60.00
Sutton Sean B. Physical Level 3 232.00 $232.00
nMed Program $10,00 $10.0 0
Treadmill PFE 1
Funct Move Screen Pk $55.00 $55.00
Chest PA/LAT $60.00 $60.00
08/08/08 Bondurant Jeff S. 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
Buttler, James N. No -Show Fee 40.00 $40.00
Cromlich Mark A. 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 $55.0 0
INVOICE
,ro Public Safety Medical Services
324 E. New York Street
E s Suite 300
Indianapolis, IN 46204
c. Carmel Fire Department I CARMEFD
-1 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 08/12/2008
m' Invoice 00 -09675
Date :r tEmpldyee Description Arhount BalsnceiDae
Fuchs Jeffery W. Ph sical (Level 3) 232.00 $232.00
OnMed Pro ram $10,00 $10.00
Treadmill (PFE) $165.00 $165.0 0
Funct Move Screen 5
Hughes, Chad 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
Peterson Vernon A. No -Show Fee $40.00 $40.0 0
Price Joseph P. Physical Level 3 232.00 $232.00
OnMed Program 10.00 $10.00
Treadmill (PFE $165.00 $165.001
Funct Move Screen Pk 55.00 55:00
Wynn, Barbara M. 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
Total Charges ';'$17;556!00
d Total Payments 8 Balance'Due x'$0:00 '`$17';556x00'
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
$17,556.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO ACCT# /TITLE AMOUNT
Board Members
1120 9675 43- 407.01 $17,556-00 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
1 811 I >I A 2009
d
4
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))
08/12/08 9675 Dept. Physicals $17,556.00
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer