160538 06/10/2008 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $1,806.00
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 160538
CHECK DATE: 6/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 9269 747.00 MEDICAL EXAM FEES
1110 4340701 9270 227.00 MEDICAL EXAM FEES
1110 4340701 9299 832.00.MEDICAL EXAM FEES
I
7 INVOICE
o; Public Safety Medical Services
324 E. New York Street
�Ew Suite 300
Indianapolis, IN 46204
o Carmel Police Department/ CARMEPD
F7 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 05127/2008
Invoice 00 -09270
_.:Date Employee 'Description, Amount 'BalaneeOue
05/21/08 Mulligan, Laura J. Injection Fee Civilian $10.00 $10.00
Hepatitis B Vaccination #2 $70.00 $70.0 0
05/22/08 Foster Johnathan A. Exec 1 Wellness 61.00 $61.0 0
HIV $0.00 $0.00
PSA $36.00 $36,00
uantiferon Tb Gold $50.00 50.00
Total Char es $227:00, 4
=Total Payments Balance "Dve $0:00_ $227[00;
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
P Public Safety Medical Services
324 E. New York Street
.r
Suite 300
Indianapolis, IN 46204
c Carmel Police Department/ CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 06104/2008
Invoice 00 -09299
Date Employee' Description Amounti Balance Due
05/29/08 Collins. Willie H. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
Flexibilitv Check $7,00 $7.00
Waist/Hi Ratio $0,00 0.00
05130108 Foster Johnathan A. 10 Cities $234.00 $234.0 0
OnMed Program $10.00 10.00
Treadmill (PFE) $165.00 $165,00
Flexibility Check $7.00 $7.00
Waist/Hi Ratio $0.00 0.00
Total Charges
Total Payments`& Balance 'Du' $6A01—:' =$832:00`
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 Services Purchase Order No.
324 E. New York Street, Suit 300 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
5/27/08 9270 payment for officer phyicals and civilian hepatitis shot 227.00
6/4/08 9299 payment for office physicals 832.00
Total 1,059.00
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 unic Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
1,059.00
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 9270 407 -01 227.00 bill(s) is (are) true and correct and that the
1110 9299 407 -01 832.00 materials or services itemized thereon for
which charge is made were ordered and
received except
June 6 20 08
Signature
Chief of Police
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund
INVOICE
o:. Public Safety Medical Services
324 E. New York Street
E, Suite 300
fY Indianapolis, IN 46204
Carmel. Fire Department/ CARMEFD
c Terms
2 Civic Square
Carmel, IN 46032 Invoice Date 05/2712008
Invoice 00 -09269
Date
"Employee Description ,Arrtiount.
Balance�Due s
05/23/08 Buttler, James N. Exec 1 Wellness Offsite $61.00 $61.00
Blood Type $22.00 $22.0 0
Drake Carl D. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.0 0
Blood TVD $22.00 $22.00
Fa in Timothy D. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood T e $22.00 $22.0 0
Hoffman Matthew F. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
Blood Type $22 QQ $22
Ryan, Christopher D. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 0.00
Blood Type $22,00 $22.00
Stindle Kevin R Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood Type $22.00 $22.0 0
Utzig, Chad M. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Workman William J. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
Blood Iyoe 122M $22.00
Young Andrew S. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood Type $22.00 $22,00
o- Tdtal;Chiarges $747:0
r
F`< Total Pe tnents, &:Balance °Due $O OD, $747 00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
VOU4 1 NO. WARRANT NO.
ALLOWED 20
Pdblic Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$747.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 9269 43- 407.01 $747.00 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
r
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))
05/27/08 9269 Exams $747.00
I hereby certify that the attached invoice(s), or bili(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
2a
Clerk- Treasurer