159555 05/14/2008 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $14,287.00
ti f ;?o CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 159555
CHECK DATE: 5114/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 9117 8,877.00 MEDICAL EXAM FEES
1110 4340701 9118 61.00 MEDICAL EXAM FEES
1120 4340701 9146 5,075.00 MEDICAL EXAM FEES
1110 4340701 9147 274.00 MEDICAL EXAM FEES
I
i
INVOICE
p Public Safety Medical Services
324 E. New York Street
,bE Suite 300
Indianapolis, IN 46204
o Carmel Fire Department! CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 04/3012008
m? Invoice 00.09117
�:`Amount Balanceue
Due
Date t Employee Description'.
04/21/08 Anderson D. Coa Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.0 0
Blood Type 22.00 $22.0 0
Baskerville Anthony A. Exec 1 Wellness Offsite $61.00 scil .00
HIV $0.00 $0.00
Blood Type $22.00 $22.0 0
Butts Joseph A. Exec 1 Wellness Offsite $61.00 $61.0 0
Blood Type $22.00 $22.0 0
Carter Gary L. Exec 1 Wellness Offsite $61.00 $61.0 0
IV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Edwards Daniel E. Exec 1 Wellness Offsite $61,00 $61.0 0
HIV $0.00 $0.00
Blood Type $22,00 $22.00
Ellison Christopher M. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
Blood Type $22.00 $22,0 0
Foster James P. Exec 1 Wellness Offshe $61.00 $61.0 0
HIV $0.00 $0,00
PSA $36.00 $36.0 0
Blood 2
Gu eE Mark E. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.0 0
Haboush. David G. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 0.00
Blood T $22.00 $22.00
Henslev. Robert P. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36,00 $36.00
Blood T e $22.00 $22.0
Hot Gary Exec 1 W I Off site $61.00 $61.0 0
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22,00 $22.00
Hulett Mark A. Exec 1 Wellness Offsite $61,00 $61.0 0
HIV $0.00 $0.00
PSA $36.00 $36,00
Blood Type $22.00 $22.00
Knott Bruce A. Exec 1 Wellness Offsite $61.00 $61.0 0
Blood Type 22.00 $22.0 0
Lenze Theodore A. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 0.00
INVOICE
o Public Safety Medical Services
324 E. New York Street
`E Suite 300
,iX Indianapolis, IN 46204
o Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 04/30/2008
Invoice 00 -09117
Date `-r Em to e
p y e� Description Amouht Balance'Due
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Miller Scott G. Exec 1 Wellness Offsite $61.00 $611.0 0
HIV $0.00 $0,00
Blood Type $22.00 $22.00
Mona han Timothy J. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 136.00
Blood Type $22.00 $22,00
Nicle Wes W. Exec 1 Wellness Offsite $61.00 61.00
Blood Type $22.00 $22.00
Platt Jace P. Exec 1 Wellness Offsite $61.00 $61.00
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Reeves Neil P. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Reeves Stephen J. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36,00 $36.0 0
Blood Type $22.00 22.00
Reppert, Ian T. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV 0.00 $0.00
Blood Type 122.00 $22.00
Sutton Sean B. Exec 1 Wellness Offsite $61.Q0 $61.0 D
HIV $0.00 0.00
Blood Type $22.00 $22.00
Tierney, Scott A Exec 1 (Wellness) Off site $61.00 $61.0 0
HIV $0.00 $0.00
Blood Type $2100 $22.00
Viehe Richard E. Exec 1 Wellness Offsite 61.00 $61,OC
HIV $0.00 0.00
PSA $36.00 36 -00
Blood Type $22.00 $22.0 0
Voskuhl Mark J. Exec 1 Wellness Offsite $61.00 61.00
HIV $0.00 $0.00
Blood Tvo $22.00 $22.00
Walker Chdsto her E. Exec 1 Wellness Offsite $61.00 $61.00
H IV 00
BI 0 $22.
Webb Gregory A. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Weddin ton Kurt L. Exec 1 Wellness Offsite $61,00 $61.0 0
HIV $0.00 $0.00
Blood Type 22.00 $22.00
W ant Andrew D. Exec 1 Wellness Offsite $61.00 $61.00
INVOICE
"o Public Safety Medical Services
324 E. New York Street
E.
Suite 300
X Indianapolis, IN 46204
o Carmel Fire Department CARMEFD
Terms
2 Civic Square
Carmel, IN 46032 Invoice Date 05107/2008
m Invoice 00 -09146
...'Date Employee Description Amount Balance Due
04/29/08 Bartrom. Brad A. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type 22.00 $22.0 0
Baskerville, Steven P. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Benbow, Kip S. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
Blood Type $22.00 $22.0
Brandt, Gary D. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Ca Shaw, Jeffrey A. PSA $36.00 $36,0 0
Exec 1 Wellness Offsite $61.00 $61.0 0
Blood Type $22.00 $22.00
Castor. Rick S. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
PSA 36.00 $36.0 0
Blood Type $22,00 $22.0 0
Co x, Justin Nt. Exec (Wellness) Offsite $61.00 $61
HIV $0.00 $0.00
Blood Tvoe $22.00 $22.00
Cummins. Frank C. Exec 1 Wellness Offsite 61.00 61.00
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Dufek. Gary J. Exec 1 Wellness Offsite $61.00 $61.00
HIV 10.00 $0.00
PSA $36,00 $36.00
Blood Tvoe $22.00 $22.00
F e Steven R. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00
Blood T 22. 00 $22.0
Gipson, Bruce E. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type 22.00 $22.00
Haymaker, Samuel K. Exec 1 Wellness Offsite 61.00 $61.0 0
HIV $0.00 0.00
PSA $36.00 $36.001
Blood Type $22.00 $22.00
Hoover, Anthony B. Exec 1 Wellness Offsite $61.00 $61.0 0
Blood Type 22.00 $22.00
Kelsheimer, Troy W. I Exec 1 Wellness Offsite 61.00 $61.00
INVOICE
o Public Safety Medical Services
324 E. New York Street
Suite 300
Indianapolis, IN 46204
Carmel Fire Department CARMEFD
Terms
2 Civic Square Invoice Date 05/0712008
m Carmel, IN 46032
Invoice 00 -09146
Date..
Employee Description' Amount Balance',Due
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Kilburn Ro er L. Exec 1 Wellness Offsite $61.00 61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Marcum Bradley D. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0,00 $0.00
Blood Type $22.00 $22.0 0
McNab. John D. Blood Type $22,00 $22,0 0
Exec i Wellness Offsite $61.00 $61.0 0
HIV $0,00 $0.00
PSA 36.00 $36.00
McNeely, Michael W. Exec 1 Wellness Offsite $61.00 61,00
HIV $0,00 $0.00
Blood Tvoe $22.00 $22.00
Mead. David L. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Mulford David A. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Plumer, Charles J. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0,00
Blood Tvoe $22.00 $22.0 0
Smith Brian E. Exec 1 Wellness Offsite $61.00 $61.0ol
HIV
Blood Type $22.00 $22.00
Sombke. Brad D. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Starr. Gregory A. Exec 1 Wellness Offsite $61.00 $61.00
HIV 0.00 $0.00
PSA $36.00 VU 0
Blood Type $22,00 $22.00
Stroup Scott A. Blood Type $22.00 $22,00
E xec 1 Wellne ffsit e $61.0 1.00
HIV $0.0
Thompson James L. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood TvQe $22.00 $22.00
Toney, James D. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 36.00
INVOICE
o Public Safety Medical Services
324 F. New York Street
Suite 300
m.
-m Indianapolis, IN 46204
o`' Carmel Fire Department 1 CARMEFD
E- 2 Civic Square Terms
m Carmel, IN 46032 Invoice Date 05/07/2008
Invoice 00 -09146
Date" Employee °Description' .-Amount.. Balance Due
Blood Type $22.00 $22.00
Weaver. Virgil L Exec 1 Wetness Offsite $61.00 $61,00
HIV $0.00 $0.00
Blood Type $22.00 $22.0 0
04/30/08 Bowles. Orbie H. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Butts Renee L. Exec 1 Wellness Offsite 61.00 61.00
Blood TvDe $22.00 $22.00
Callahan, Mark Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Condra Kyle E. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0,00 $0.00
Blood Type $22.00 $22.0 0
Crane. Barry L. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0,00
PSA $36.00 $36.00
Blood 7vne $22.00 $22.00
Crisler John H. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.0
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Deitsch. Marc W. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood Type $22,00 $22.0 0
Essex, Co C. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0. 00 $0.00
PSA $36.00 $36.0 0
Blood Type 22.00 $22.00
Fisher Gary L. Exec 1 Wellness Offsite $61.00 $61.00
HIV 1 0 $0.00
PSA $36. 136 .0
Blood Type $22.00 $22.00
Frost. Bruce S. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Gdffiin, Timothy M. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0,00
Blood T e $22.00 $22,0 0
Games Jeffrey A. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood TvQe 22.00 $22.0 0
Love Jose h B Exec 1 Wellness Offsite $61.0o 61.00
INVOICE
o Public Safety Medical Services
;y 324 E. New York Street
E Suite 300
x Indianapolis, IN 46204
Carmel Fire Department 1 CARMEFD
Terms
2 Civic Square
Carmel, IN 46032 Invoice Date 05!0712008
m Invoice 00 -09146
Date "Employee Description ,;Amount Balance Due'
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.0 0
Payne. Thomas C. Fxec 1 (Wellness) Offsite 61. D $61.Q 0
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Reecer, Jason L. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA 36.00 $36.0 0
Blood Type $22.00 $22.0 0
Reynolds. Shawn J. Exec 1 (Wellness) Offsite $61.00 $61.D 0
HIV $0.00 $0.00
PSA 36.00 $36.00l
Blood Type 122.00 $22.0 0
Rohr. Christoipher M. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Small, Thomas D. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Soelbrin James E. Exec 1 Wellness Offsite 61.00 161.0 0
PSA $36.00 $36,00
Blood Tyne $22.00 $22,0 0
Steele Jeffrey A. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
PSA $36.00 $36.0 0
Blood Type $22.00 $22,00
Steury. Kent C. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0,00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 22.OD
.L sTotal Charges $5;075:00
ToEal-Pa" nits' °Bala'nce;Due r 0:00. :$5;075:00:
1
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
`E Suite 300
�Ft Indianapolis, IN 46204
d Carmel Fire Department I CARMEFD
2 Civic Square Terms
t; Carmel, IN 46032 Invoice Date 0413012008
m:'' Invoice 00 -09117
i .Employee ;pascription': ;;Amo'
ue
alance
Date' unt B Dy
HIV $0.00 $0.00
Blood Type $22.00 $22.00
04/22108 Bondurant Jeff S. Exec 1 Wellness Offsite $61.00 61.00
HIV jago $0.00
PSA $36,00 $36.00
Blood Type $22.00 $22.0 0
Collins Tony A. Exec 1 Wellness Offske $61.00 $61.00
HIV $0.00 0.00
PSA $36.00 $36.0 0
Blood TVQ $22.00 $22,00
C onner. oth Ex 1 e e s Offsite $61.00 $61
HIV $0.00 $0.00
PSA $36.00 $36.0 0
Blood Tvne $22.00 $22.0 0
Cromlich Mark A. Exec 1 Wellness Offsite $61.00 $61.00
HIV 10.00 $0.00
PSA 36.00 36.00
Blood Type $22.00 $22.00
Davis James M. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 22.00
Dorsch James Exec 1 elan Offsite $61.00 $61 00
HIV $0.00 $0.00
PSA $36.00 36.00
Blood T e $22.00 $22.00
Fuchs Jeffery W. Exec 1 Wellness Offsite $61.00 $61,0 D
HIV $0.00 $0.00
Blood Type $22.00 $22,00
Gehibach Marc A. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood Type $22,00 $22,0 0
Howard Wendell E. Exec 1 Wellness Offske $61,00 $61.00
HIV 0.
P 6.00 $36.00
Blood Type $22.00 $22.00
Hughes Chad L. Exec 1 Wellness Offsite $61.00 $61.00
HIV 0.00 $0.00
PSA $36.00 $36.0 0
Blood Type $22.00 $22.0 0
Johnson Jeremy S. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood Type 22.00 $22.0 0
Maroon Ernie R. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0,00
PSA $36.00 $36.00
INVOICE
;�o Public Safety Medical Services
324 E. New York Street
Suite 300
Indianapolis, IN 46204
Carmel Fire Department! CARMEFD Terms
2 Civic Square Invoice Date 04130/2008
m' Carmel, IN 46032
Invoice 00 -09117
p y P
.Date, =e= ��.Em to ee Desen lion Amount Balance Due
Blood Tyne $22.00 $22.00
Orancie. Douglas D. Exec 1 Wellness Offsite $61.00 $61.00
HIV 0.00 $0.0 0
Blood Tyve $22.DC $22,0
Phillips, Craig M. Exec 1 Wellness Offske $61.00 $$1.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Price Joseph P. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0,00 $0.00
PSA $36.00 $36.0 0
Blood Type $22.00 $22.0 0
Robinson. Mark G. Exec 1 Wellness Offsite $61.00 $61,00
HIV $0.00 $0.00
PSA $36.00 $36.0 0
Blood Tvo $22.00 $22.0 Q
Utziq, Todd T. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Vallone Frank Exec 1 Wellness OffsRe $61.00 $61.00
HIV $0.00 $D.00
PSA $36,00 $36.00
Blood Type $22.00 $22.0 0
VanVoorst Robert J. Exec 1 Wellness Offsite $61.00 $61.00
PSA $36.Q0 $36.0 0
Blood Tyo $22.DO $22.00
Wynn, Barbara M. Exec 1 Wellness Offste $61.QQ $61.0 0
HIV $0.00 $0.0
Blood Type $22.00 $22.00
04124108 Contino David M. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.0 Q
Blood Type $22.00 $22,0 0
Frenzel Eric C. Exec 1 Wellness Offsite 161.00 $61.00
HIV $0.00 so.0o
PSA 36.00 $36.00
Blood Tvo $22.00 $22.00
Giles William G. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
B lood Tvoe $22. $22.
Har rinaton. Adam C. Exec Ilne Offsite 1.00
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Holden Adam D. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $D.00 $0.00
PSA $36.00 36.00
Blood Typ $22,00 22.00
Holubik Steven W. Exec 1 Wellness Offsite $61.00 61.00
INVOICE
o Public Safety Medical Services
324 F. New York Street
E Suite 300
(X;; Indianapolis, IN 46204
o Carmel Fire Department/ CARMFFD
f- 2 Civic Square Terms
Carmel, IN 46032 Invoice Date 04130/2008
Invoice 00 -09117
Date Employee Description ;Amount, Balance Due:
HIV $0.00 $0.00
PSA $36.00 $36.0 0
Blood Type $22.00 $22.00
Keaton Anthony R. Exec 1 Wellness Offske $61.00 $61.0 0
HIV Saw $0.00
Blood Type $22.00 $22.0 0
Kehl, William D. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36,00 $36.0 0
Blood TVQe $22.00 $22.00
Lux, Michael T. Exe 1 W I es Offsite 61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.0 0
Martin, Richard A. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA 36.00 $36.0 0
Blood Type $22,00 $22.0 0
Mead Jr. Donald R. Exec 1 Wellness Offsite $61.00 $61.00
HIV 0.00 $0.00
PSA $36.00 $36.0 0
Blood Tyl2e $22.00 $22.0 0
M itchell, James Ex (Wellness) Offsi $61.00 $61.0 0
HIV $0.00 $0.00
Blood Type 22.00 $22.00
Osborne Scott K. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0,00 $0.00
PSA $36.00 36.00
Blood Type $22,DO $22.00
Peterson Vernon A. Exec 1 Wellness Offsite $61.00 $61.0c
HIV $0.00 $0.0 0
PSA $36.00 $36.0 0
Blood Type $22,00 $22.00
Robin on, Mitchell L. E e (Wellness) Offs1te 6
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Schooley Dustin D. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Shay Adam C. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0,00
Blood Type $22,00 $22.00
Younci, Alan R. Exec 1 Wellness Offsite $61.0Q $61.00
HIV $0.00 $0.00
PSA $36,00 36.00
Blood T e $22.00 $22.00
INVOICE
o Public Safety Medical Services
324 E. New York Street
'E` Suite 300
Indianapolis, IN 46204
-o 'ti Carmel Fire Department 1 CARMEFD Terms
h. 2 Civic Square Invoice Date 04/30/2008
m Carmel, IN 46032
Invoice 00 -09117
Date �Ernglayee! Descrjptiori Amount. Balancebue'
Zeller. Michael J. Exec 1 Wellness Offsite $61,00 $61.00
HIV $0.00 $0,00
Blood Type $22.00 $22,0 0
4/ Allen, Brad A Exec W line Offsite $61.00 $61,
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Alverson Jonathon L. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.0 0
Bailey, Mark E. Exec 1 Wellness Offsite $61,00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.0 0
Blood Type $22.00 $22.G 0
Brant Kenneth E. Exec 1 Wellness Offsite 61.00 61.00
HIV $0.00 $0.00
Blood TVp e $22.00 $22.00
Brisco Michael D. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 0.00
Blood Type $22.00 $22,00
DeCrastos Richard A. Exec 1 Wellness Offsite 61.00 $61.0 0
HIV $0.00 $0,00
PSA $36.00 $36.00
Blood T e $22.00 $22.00
DeLong Michael T, Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
Blood TvD $22.00 $22.00
E S L. Exe 61.00 $6
HIV $0.00 $0.00
Blood Type $22.00 $22.00
Freer Keith T. Exec 1 Wellness Offsite $61,00 $61.00
HIV $0.00 $0. 00
Blood Type $22.00 $22.0 0
Horner David W. Exec 1 Wellness Offsite $61.00 $61,0 0
HIV $0.00 $0.0 0
PSA $36.00 36.00
Blood Type $22.00 22.00
Kinney, Jared N. Exec 1 (Wellnessl Offsite $61.00 $61.00
HIV $0,00 $0.00
Blood Type $22.00 $22-G
Marsh, Michael A. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22.00 $22.00
Martin David D. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
PSA $36.00 36.00
INVOICE
Public Safety Medical Services
324 E. New York Street
i'- Suite 300
Indianapolis, IN 46204
I Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 04/3012008
Invoice 00 -09117
Date: ...:Employee Description,:;, Amount Balance'�Diie.
Blood Type $22.00 $22.00
Medlen Michael J. Exec 1 Wellness Offsite 61.00 $61.0 0
HIV $0. 00 $0.00
PSA $36,00 $36.00
Blood Type $22.00 $22.00
Moriarty, John F. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0.00
PSA $36.00 $36.0 0
Blood Type $22.00 $22.00
Paddock Ronald D. Exec 1 Wellness Offsite $61,00 $61.00
IV $0 S0.00
Blood Type $22.00 $22.00
Wendzel Jason D. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
Blood T e $22.00 $22.00
Whitaker Charles E. Exec 1 Wellness Offsite $61.00 $61,00
HIV $0.00 $0.00
PSA $36.00 $36.00
Blood Type $22,00 $22.0 0
Witsken. Steven J. I Exec 1 Wellness Offsite $61,00 61.00
HIV $0.00 $0.00
PSA $36. $36.0 0
Blood T 2.00 22.00
T661 'rges
r,r Total Payments Balance'Due $0:00 $8,877:00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
VOUCHER NO, WARRANT NO.
ALLOWED 20
P�Iblic Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$13,952,0
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 9117 43- 407.01 $8,877.00 1 hereby certify that the attached invoice(s), or
1120 9146 43- 407.01 $5,075.00 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
d
l
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No 201 (Rov. 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))
04/30/08 9117 Physicals for Personnel $8,877.00
05/07/08 9146 Physicals for Personnel $5,075.00
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
4 0' Public Safety Medical Services
w,.
324 E. New York Street
"E Suite 300
d
Indianapolis, IN 46204
Carmel Police Department CARMEPD Terms
3 Civic Square Invoice Date 04/30/2008
m Carmel, IN 46032
Invoice 00 -09118
Date r`. Employee, Description Amount,.., Balance Due
04/17!08 Semester, James S. Exec 1 Wellness Offsite $61.00 $61.00
.'Total Charg es
?,$61.00
Total Pa merits& Balance Due $0.00 $61.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
0 Public Safety Medical Services
324 E. New York Street
'E 300
ar
Indianapolis, IN 46204
0- Carmel Police Department I CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 05/07/2008
m Invoice 00.09147
Employee's Description iAmount. Balance Due.:
04/29/08 Semester. James S. 10 Cities $234.00 $234.00
Body Fat Check Bod Pod $23.00 $23.00
Hexibility Check $7.00 $7.00
Waist/Hi Ratio $0.00 $0.00
OnMed Program $10.00 $10.00
Total Charges ':'$274.00
.Total Payments Balance` Due ?$0:00 $274.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Prescribed by Slate Board of Accounts City Form No. 201 (Rev. 1995)
f 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, Suite 300 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4/30/08 9118 pay,ent for officer physical 61.00
5/7/08 9147 payment for officer physcial 274.00
Total
1 hereby certify that the attached invoice(s), or biil(s), is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Pubs' is Safety Medical Services IN SUM OF
324 E. New York Street:, Suite 300
Indianapolis, IN 46204-,.
.335-00--.
ON ACCOUNT OF APPROPRIATION FOR
policd general fund
Board Members
Pots or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT 1 hereby certify that the attached invoice(s), or
1110 9118 407 -01 61.00 bill(s) is (are) true and correct and that the
1110 9147 407 -01: 274.00 materials or services itemized thereon for
which charge is made were ordered and
received except
May 8 20 08
Signature
Chie£ of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund