162477 08/07/2008 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,776.00
i Fio CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
ti�,puiY INDIANAPOLIS IN 46204 CHECK NUMBER: 162477
CHECK DATE: 8/7/2008
DEPARTMENT ACCOUNT P O NUMBER INVOICE NUMBER AMOU DESCRIPTION
1120 4340701 9552 63.00 MEDICAL EXAM FEES
1110 4340701 9553 1,726.00 MEDICAL EXAM FEES
1110 4340701 9596 1,987.00 MEDICAL EXAM FEES
INVOICE
4 o Public Safety Medical Services
324 E. New York Street
S� Suite 300
X Indianapolis, IN 46204
.0� Carmel Police Department CARMEPD
Terms
3 Civic Square Invoice Date 07/2312008
Carmel, IN 46032
Invoice 00-09553
Arridunt; Balance Due
Description
07118/08 Loveall. Gregory A. Indiana Police/Fire PERF $575.00 $575,00
Tb Skin Test $0.00 $0.00
Applicant Health Screen PERF $0.00 $0.00
Pitman, Michael A. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.0
Treadmill (PFE) $165.00 $165.00
Flexibility Check $7,00 $7.00
Waist/Hir Ratio $0M $0.00
Renforth. TrevQr M, Indiana Police/Fire, PERF $575.00 $575.00
Tb Skin Test $0,00 $0.00
Apolicant Health Screen PERF $0.00 $0.00
Total Payments B6 ance'Dde �0boT $1,726.00'
Please write invoice number on payment check.
Our Federal Employer Identifica Number io35'2O7Q7Q7
INVOICE
Public Safety Medical Services
324 E. New York Street
Suite 300
1�' Indianapolis, IN 46204
Carmel Police Department 1 CARMEPD
Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 07/30/2008
co Invoice 00 -09596
'",Date °4 k ,y' Employee .;Descriptiom: mount-- l Balance =Duey^
07/21/08 Hood, Bryan L. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
Flexibility Check $7.00 7.00
WaistMi Ratio $0.00 $0.00
07/22/08 Lovitt Richard A. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.0 0
Treadmill (PFE $165.00 165.00
Flexibility Check $7.00 $7.0 0
Waist/Hi Ratio $0.00 $0.00
0 7/24/08 r se Exec W Ilne s Offsite 1.0 61.00
HIV 1 2 $0.00 $0.00
Quantiferon Tb Gold $50.00 $50.00
Harris Robert P. Exec 1 Wellness Offsite $61.00 $61.00
HIV 1 &2 0.00 $0.00
Quantiferon Tb Gold $50.00 $50.00
Locke Robert E. Exec 1 Wellness Offsite $61.00 61.00
HIV 1 2 $0,00 $O.OD
Quantiferon Tb Gold $50.00 $50.00
Lytle. Blake A. Exec 1 Wellness Offsite $61.00 $61.00
HIV 1 2 10.00 0.00
Q uantiferon Tb Gold $50.00 $50.0 0
Pelzer. RgLgrt S, 10 Cities $234.00 4.
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
BodV Fat Check Bod Pod $23.00 $23.00
Fiexibilitv Check $7.00 $7.00
Waist/Hi Ratio $0.00 $0.00
Rickard Teressa D. Quantiferon Tb Gold $50.00 $50.00
Schoeff, Jr. Donald D. Exec 1 Wellness Offsite $61.00 61.00
HIV 1 2 $0,00 $0.00
Q uantiferon Tb Gold 50.00 $50.0 0
Scott Curtis D. Quantiferon Tb Gold $50.00 50 -0
Exe (Wellness) Offsite 1.0
IHI V1 .00 1 so-0
x Total, Chiarges $1;987:00
Total Payments Balance`Due $0.00 $1 987:00'
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Y PrescriC'tl 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, Sytife 300 Terms
IndianaPali s, IN 46704 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
7123/08 9553 P avment for officer Physicals 1,726.00
6 a ent for officer physicAls 1,987.00
Total 3 713.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
P 4 ublic Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
3,713.00
ON ACCOUNT OF APPROPRIATION FOR
p olice general ufnd
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 9553 407 -01 1 726.00 bill(s) is (are) true and correct and that the
1110 9596 407 -01 1,987.00 materials or services itemized thereon for
which charge is made were ordered and
received except
July 31 2008
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
s
INVOICE
o Public Safety Medical Services
324 E. New York Street
Suite 300
Indianapolis, IN 46204
o' Carmel Fire Department l CARMEFD
F-` 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/23/2008
Invoice 00 -09552
'E
Date —Desc =Amount Bafance Due
07/14/08 Haus, Joshua S. Tb Read $0.00 $0.00
07/17/08 Hutchison, Brian P. Repeat Chest X -Ray 0.00 $0.00
07/18/08 Haus Joshua S. Repeat Glucose. Fasting 21.00 $21.0 0
Watts Trent E. Repeat Glucose. Fasting 21.00 $21.0 0
Total Charges __$42:00
r $0 °00 "_.$42i001
Total'f?aymerits;8 B alance Due
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
o: Public Safety Medical Services
324 E. New York Street
E; Suite 300
Indianapolis, IN 46204
Carmel Fire Department 1 CARMEFD Terms
2 Civic Square Invoice Date 07/30/2008
Carmel, IN 46032
Invoice 00 -09595
Date• ':Employee-- t �"De'scription` Amount BalanceiDue
07/23/08 Drinkwater, Heather L. Repeat Glucose, Fasting $21.00 $21,00
x Total Cha'�ges $21"
"Total 'Pa ments 8 "Balance Due "$0:00
Please write invoice number an 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
$63.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 43- 407.01 $21.00 1 hereby certify that the attached invoice(s), or
1120 9552 43- 407.01 $42.00 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
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))
Recruit Evaluation $21.00
07/23108 9552 Exams $42.00
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