161527 07/11/2008 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: $2,194.00
'+o INDIANAPOLIS IN 46204
CHECK NUMBER: 161527
CHECK DATE: 7/11/2008
PARTMENT ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION
1110 4340701 9422 122.00 MEDICAL EXAM FEES
1110 4340701 9459 2,072.00 MEDICAL EXAM FEES
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
e 3 Carmel Police Department 1 CARMEPD
Terms
3 Civic Square Invoice Date 06/24/2008
Carmel, IN 46032
Invoice 00 -09422
Date r .fs Employee:: I]escnption r'r° L.x s Amounf rF. Baf ce
an:D'u
e
06/16/08 Pitman Michael A. Exec 1 Wellness Offsite $61.00 $61.00
HIV 1 2 $0.00 $0.G0
06117/08 Titson Travis C. Exec 1 Wellness Offsite $61.00 $61.0 0
'Z' x t,La7 °rx et.3 tie -x,� P Z 8 t s k x'•ax r 1
�..r: �q a`� i `—.x a s mv` '4 .�,cTotal Charges y 3'�. $122t i
Balancet]ie;> :$0;00^ $122.00`
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
Suite 300
Indianapolis, IN 46204
0, Carmel Police Department CARMEPD Terms
3 Civic Square
Invoice Date 07/0112008
Carmel, IN 46032
Invoice 00-09459
Employ
06/03/08 Bickel, ScottW. Exec 1 (Wellness) Offsite $61.00 $61.00
06/24/08 Frost, Dwight D. Exec 1 (Wellness) Offsite $61.00 $61.00
06/25/08 Buftic Jennifer R. Exec 1 (Wellness) Offsite $61.00 $61.0
Exec Offsite $61M- $61.0
Hood, Bryan L. Exec 1 (Wellness) Offsite $61.00 $61.0
Lovitt, Richard A. Exec 1 (Wellness) Offsite $61.00 $61.00
Pelzer, Robert S. Exec 1 (Wellness) Offsite $61.00 $61,0
Vanderbeck, David R. Exec 1 (Wellness) Offsite $61.00 $61.00
06/26/08 Bickel, Scott W. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 $165,00
Flexibility Check $7.00 $7.00
Waist/Hip Ratio $0.00 $0.00
OnMed Program $10.00 $10.0
Bodenhorn, Wendy M. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 $165.00
Flexibility Check $7.00 $7.00
Waist/Hii) Ratio $0.00 $0.00
OnMed Program $10.00 $10.0
--Tilson.-TiavisC. 10 Cities $234.00 $234.0
Treadmill (PFE) $165.00 $165.00
Flexibility Check $7,00 1 $7.00
Waist/Hir) Ratio $0.00 $0.00
Onmed Program $10.00 $10.00
:,TofalP�Y'hie alance:Due bd]
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35-2078797
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 Service Purchase Order No.
324 E. New York Street, Suite 30 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6/24/08 9422 payment for officer physical 122.00
7/1/08 9459 payment for officer physicals 2,072.00
Total 2,194.00
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
P ublj_c Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
2.194.00
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 9422 407 -01 122.00 bill(s) is (are) true and correct and that the
1110 9459 407 -01 2,072.0 materials or services itemized thereon for
which charge is made were ordered and
received except
July 2 2008
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund