162010 07/23/2008 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $6,181.00
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 162010
CHECK DATE: 7/23/2008
DEPARTME ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION
1110 4340701 9517 1,771.00 MEDICAL EXAM FEES
1120 4340701 9541 4,410.00 MEDICAL EXAM FEES
jf
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
x Indianapolis, IN 46204
G' Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 07/16/2008
Invoice 00 -09517
Date Employee Description Amount Balance Due
07/03/08 Wiegman Chad R. Exec 1 Wellness Offsite $61.00 $61.00
HIV 1 2 $0.00 $0.00
07/07/08 Frost Dwight D. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 $165.00
Flexibility Check $7.00 $7.00
Waist/Hi Ratio $0.00 $0.00
OnMed Program $10.00 $10.00
Harting, Charles V. 10 Cities $234.00 $234.00
OnMed Pro ram $10.00 $10.0 0
Treadmill (PFE) $165.00 $165.00
Body F
Flexibilitv Check $7.00 $7.00
Muscle Strength Endurance $23.00 $23.0 0
Waist/Hi Ratio $0.00 $0.00
07/08/08 VanNatter, Shane R. 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
07/11/08 Wiegman, Chad R. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 $165.00
Flexibility Check $7.00 $7.00
Ra ti o
OnMed Program $10.00 $10.00
Total Charges $1,771.00
Total Payments Balance Due $0.00 $1,771.00,
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 Supplies 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))
7/16/08 9517 payment for officer physicals 1,771.00
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.
ti
ALLOWED 20
P ublic Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
1.771.00
ON ACCOUNT OF APPROPRIATION FOR
p olicd g enera l f
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 9517 407 -01 1,771 .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
July 18 2008
1
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
INVOICE
F°- Public Safety Medical Services
324 E. New York Street
,E Suite 300
�W Indianapolis, IN 46204
Carmel Fire Department l CARMEFD Terms
2 Civic Square
Carmel, IN 46032 Invoice Date 07/16/2008
Invoice 00 -09541
Date Employee p ti F. p
€7escn tiori' Amours"
u ,�,j a SSN /lD_, t B'alancw ue,
07/09/08 Ray, Lucas M. 312 -02 -6559 Indiana Police /Fire PERF $575.00 $575.00
Chest PA/LAT 55.00 $55.00
Tb Skin Test $0.00 0.00
ADDlicant Health Screen PERF $0.00 $0.00
Woodburn Scott E. 314 -02 -7803 Indiana Police /Fire PERF $575.00 $575.00
Chest PAILAT 55.00 $55,0 0
Tb Skin Test $0.00 $0.00
Color Vision Farnsworth 0.00 $0.00
Aoplicant Health Screen -PERF 0:00 0.00
07/10/08 Drinkwater. Heather L. 305-80-2934 Indiana Police/Fire PERF $575.00 $575.00
CbasL--PNLAT $55.00 $55.00
Tb Skin Test $0.00 $0.00
Applicant Health Screen PERF $0.00 $0.00
Hutchison Brian P. 303 -02 -9136 Indiana Police /Fire PERF $575.00 575.00
Chest PA/LAT $55.00 55.00
Tb Skin Test $0.00 $0.00
Applicant Health Screen PERF $0.00 $0.00
07111/08 Haus Joshua S. 304 -08 -4720 Indiana Police /Fire PERF $575.00 $575.00
Chest PA/LAT $55.00 $55, 00
Tb Skin Test 0.00 $0.00
Applicant H lth Screen PERF $0.00 $0.00
Watts Trent E 307-74-6680 Indiana Police/Fire PERF 157500 $575-00
Chest PA/LAT 555.00 $56.00
Tb Skin Test $0.00 $0.00
Applicant Health Screen PERF $0.00 $0.00
Younq, Kevin M. 317 -84 -7137 Indiana Police /Fire PERF $575.00 $575.00
Chest PA/LAT 55.00 $55.00
Tb Skin Test $0.00 0.00
Applicant Health Screen PERF 0.00 0.00
Total Charge's, $4
Total Payments Balance Due -'sapol $4
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
VOU NO. WARRANT N O.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$4,410.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO ACCT #!TITLE AMOUNT Board Members
1120 9541 43- 407.01 $4,410.00 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
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
C{TY 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))
07/16/08 9541 Physicals for Recruits $4,410.00
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