157219 03/05/2008 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: $2,585.00
INDIANAPOLIS 1N 46204 CHECK NUMBER: 157219
CHECK DATE: 3/512008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340702 8731 80.00 SHOTS INOCULATIONS
1110 .4340701 8732 957.00 MEDICAL EXAM FEES
1110 4340701 8770 1,548.00 MEDICAL EXAM FEES
1'
rh
INVOICE
'-o' Public Safety Medical Services
w, 324 E. New York Street
E Suite 300
r -�R
it Indianapolis, IN 46204
o Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 0211912008
Invoice 00 -08731
Date Employee Descriptian� °.Amount ,i wBalanceD
ue;
02113/08 Kilburn Roger L. Hepatitis B Vaccination #2 $70.00 $70.00
Iniection Fee 10.00 $10.00
Total Charges
6tal' ments` &'Balance.Due 10:00 $80.00.
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
VOUCHER NO. WARRANT NO.
ALLOWED 20
PRiblic Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$80.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept.# INVOICE NO. ACCT /TITLE AMOUNT
Board Members
8731 43- 407.02 $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
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev- 995)
ACCOUNTS PAYABLE VOUCHER
E
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))
02/19/08 8731 Innoculation Kilburn $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
o!' Public Safety Medical Services
324 E. New York Street
cE Suite 300
W Indianapolis, IN 46204
0 7 Carmel Police Department CARMEPD
Terms
3 Civic Square Invoice Date 02/19/2008
mq z Carmel, IN 46032
Invoice 00 -08732
.Employee, 'Description T :Amount ,Balance':Due�
01/10108 Keith Brett A. Exec 1 Wellness Offsite $61.00 $61.00
02/11/08 Pirics John D. Exec 1 Wellness Offsite $61.00 $61.0 0
02112108 Keith Brett A. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 $165,00
Flexibility Check $7. 00 $7.00
Waist/Hi Ratio 10. 00 $0.00
02/14/08 Stites William R. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 $165.00
Body Fat Check Bod Pod $23.00 $23.0 0
Flexibilitv Check $7.00 $7.00
W ti .0
°.TotalECtiarges $957.00 x
Total'Payments "8 Balerice;Due $0:00 165T.DO
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
gyp° Public Safety Medical Services
wW; 324 E. New York Street
Suite 300
fez Indianapolis, IN 46204
o Carmel Police Department CARMEPD
Hy� 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 0212612008
=m Invoice 00 -08770
Employee. K, 4. Description.; F Amount Balance'Due
02/15/08 Dixon Micheal R. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0,00
PSA $36.00 $36.0 0
Elliott John R. Exec 1 Wellness Offsite 61.00 $61,0 0
PSA $36.00 $36.00
HIV $0.00 $0.00
Kin on David M. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 0.00
PSA $0.00 0.00
Laker Jeffrey W. Exec 1 Wellness Offsite $61.00 $61.00
IV $Q,00 $0.00
PSA $0.00 $0.00
White II Robert E. Exec 1 Wellness Offsite $61.00 $61.0 0
HIV $0.00 $0. 00
PSA $0.00 $0.00
02/21/08 White II Robert E. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 $165.00
Flexibility Check $7.00 $7.0 0
Waist/Hi Ratio $0.00 $0.00
OnMed Pro ram $10.00 10.00
02/22/08 Goodman Leland C. Exec 1 Wellness Offsite $61.00 61,00
HIV $0.00 $0.0 0
McNair. Harland Exe 1 W line ff ite $61.00 $6
Pirics John D. 10 Cities $234.00 $234.00
Treadmill (PFE) $165.00 $165,00
Bodv 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 $10.0 0
Strong, David C. Exec 1 Wellness Offsite $61.00 $61.00
HIV $0.00 $0.00
PSA $36.00 $36.00
Towle John R. Exec 1 Wellness Offsite $61.00 $61.00
H ly $0.Q0 0.0
PSA $36.00 $36.00
d
$1,$48100
M a Tetal Payments& Balance?Due $0:04 ;$1,548:00;
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
Prescribed ACCOUNTS PAYABLE VOUCHER by State Board of Accounts City Farm 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 York Street, /suite 300 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2/9108 8732 ipayment for officer physicals 957.00
2/26/08 8770 payment for officer physicals 1,548.00
Total 2,505-00
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
Indianaplis, IN 46204
2,505.00
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 8732 407 -01 957 .00 bill(s) is (are) true and correct and that the
1110 8770 407 -01 1 materials or services itemized thereon for
which charge is made were ordered and
received except
February 28 2008
e
Signature
Chief'=of POlice
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund