161039 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,134.00
n CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 161039
CHECK DATE: 6/25/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 R4350900 16554 00 -09344 80.00 HEALTH SCREEN EVALUAT
1110 4340701 9345 2,554. 00 MEDICAL EXAM FEES
1110 434'0701 9372 500.00 MEDICAL EXAM FEES
E INVOICE
'o'. Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
Carmel Clay Communications CARMCOM
31 First Avenue NW Terms
C1 Carmel, IN 46032 Invoice Date 06/11/2008
Invoice 00 -09344
.Employee Description ::Amount ''Balance Due
06 /04!08 Reed. Michele R. Vision Titmus $16.00 $16.00
Peripheral Vision $0.00 $0.00
Audiometry 0.00 $0.00
Audiometry W /Discrimination $64.00 $64.00
Total`Charges ,$80:00
Total' Payments Balance'Due $0.04 $80.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
J
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 E. New York Street, Ste 300
Indianapolis, In 46204
$80.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
16554 00 -09344 43- 509.00 $80.00 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
Thursday, June 19, 2008
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 199b)
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))
06/11/08 I 00 -09344 I I $80.00
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
INVOICE
e: Public Safety Medical Services
324 E. New York Street
E;. Suite 300
Indianapolis, IN 46204
Carmel Police Department! CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 06111/2008
m, Invoice 00 -09345
Date sEmployee Description Amount Balance `Due'
06/02/08 Dunlap, Christopher T. 10 Cities $234.00 $234.00
OnMed Pro ram $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
Body Fat Check Bod Pod $23.00 $23.00
Flexibility Check $7.00 $7.00
Waist/Hi Ratio $0.00 $0.00
06!05!08
Flaming, Anna G. Indiana Police /Fire PERF $575.00 $575.00
Chest PA/LAT $55.00 $55.00
Applicant Health Screen 1 $0.00 $0.00
Tb Skin Test $0.00 $0.00
06/06108 Amos, ha B. Indiana Police/Fire PERF $57 $575.00
Chest PA/LAT $55.00 $55.00
Tb Skin Test $0.00 $0.00
Applicant Health Screen PERF $0.00 $0.00
Dawson. Gregory F. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 $165.00
Body Fat Check Bod Pod $23.00 $23.00
Flexibility Check $7.00 $7.00
Waist/Hi Ratio $0.00 $0.00
OnMed Program 1000 $10.00
Jent Danny N. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 165.00
Flexibility h eck $7.00 $7.00
Waist/Hi Ratio $0.00 $0.00
Chest PA/tAT Done In Error $0.00 $0.00
OnMed Pro ram $10.00 $10.00
Total Charges 2.554.00
j
'Total Pa mehts &Balance bue $0.00 $2,554.00
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
b Carmel Police Department 1 CARM EPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 06/17/2008
Invoice 00.09372
_gym
Date �,...:u ,'�;EmployeeDescriptionArnoLnt "Balance -Due
06/09108 Pans, Mark J. Exec 1 Wellness Offsite $61.00 $61.00
06/12/08 McNair. Harland T 10 Cities $234.00 $234.00
Treadmill PI=E $165.00 $165.00
Body Fat Check Bod Pod $23.00 $23.00
Flexibility Check $7.00 7.00
Waist/Hi Ratio 0.00 0.00
OnMed Program 10.00 1 10.00 00
�otahCharges s,$500`.DO
Total PaymentsA,Balance Due $0:00 $500:00`
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 Yorl�. Street, Suite 300 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6/11/08 9345 payment for officer physicals and applicant physicals 2,554.00
6/17/08 9372 payment for officer physical 500.00
Total 3,054.00
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 ublic Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
3.054.00
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 9345 .407 -01 2,554.00 bill(s) is (are) true and correct and that the
1110 9372 40701 500.00 materials or services itemized thereon for
which charge is made were ordered and
received except
June 20 2008
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund