155867 01/23/2008 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: $4,450.00
INDIANAPOLIS IN 46204 CHECK NUMBER: 155867
CHECK DATE: 1123/2008
DE PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 8502 2,933.00 MEDICAL EXAM FEES
1120 4340701 8523 75.00 MEDICAL EXAM FEES
ill0 4340701 8524 485.00 MEDICAL EXAM FEES
1110 4340701 8563 957.00 MEDICAL EXAM FEES
INVOICE
s
o Public Safety Medical Services
324 E. New York Street
E Suite 300
ar
IY Indianapolis, IN 46204
:d Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 01103/2008
m Invoice 00 -08502
Date Employee Description Amount. Balance Due
12/18!07 Je[lison Ryan D. 10 Cities $291.00 $291.00
Treadmill (PFE) $164.00 $164.00
Flexibility Check $7.00 $7.00
Waist/Hi Ratio 0.00 $0.00
Mabie Michael L. 10 Cities $291.00 $291.00
Treadmill (RIFE) 164.00 $164.00
Body Fat Check Bod Pod $23.00 $23.00
Flexibility heck $7.00 $7.00
Waist/Hi Ratio $0.00 0.0
12119/07 Gilbert, William J. 10 Cities i $291.00
Bodv Fat Check Bod Pod $23.00 $23.00
Flexibility Check $7.00 $7.00
Muscle Strength Endurance 23.00 $2100
Waist/Hi Ratio $0.00 $0.00
Klein Marc A. Exec 1 Wellness Offsite $0.00 0.00
Miller Adam C. 10 Cities $291.00 $291.0 0
Treadmill (PFE) $164.00 $164.0 0
Body Fat Check Bod Pod $23.00 $23.0 0
Flexibility Check 7.00 $7.001
M uscle 0
WaistlHic R 0
12/28/07. Byrne, Timothy L. 10 Cities $291,00 $291.00
Treadmill (PFE) $164.00 $164.00
Body Fat Check Bod Pod $23.00 $23.00
Flex[bilitV Check $7.00 $7.00
Waist/Hi Ratio $0.00 0.00
12/31/07 Howard Lana M. 10 Cities $291.00 $291.00
Treadmill (PFE) $164.00 $164.00
Flexibility Check $7.00 $7.00
Muscle Strength Endurance 2100 S23.00
Waist/Hio Ratio S0.00 0.00
Total Charges $2,933.00
Total Payments B Balance'Due -y $0.00 $2,933.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
o Public Safety Medical Services
324 E. New York Street
Suite 300
-�34r Indianapolis, IN 46204
o Carmel Police Department I CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 01/07/2008
xm< Invoice 00 -08524
Date" 4 EMPloyee a &rDe §cnpttori`,c Amount r v
x. :,BalancekDu`e,'
01102/08 Barlow James C. Exec 1 Wellness Offsite $0.00 $0.00
Klein Marc A, 10 Cities $291.00 291.00
Treadmill (PFE) $164,00 $164.00
Body Fat Check Bod Pod $23.00 $23.0 0
Flexibilitv Check $7.00 $7.OD
Waist/Hi Ratio $0,00 1 $0.00
`"u,,& x$. �"a✓,.,'� s; d -'a s7 aY S s 4 s ?�9
x
a o Totel Charges $A85'00
t Y Y g Total Payments &EBalance`D e
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
1 '10 Public Safety Medical Services
324 E. New York Street
�XMaF
E Suite 300
q Indianapolis, IN 46204
Me-
Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032
Invoice Date 01/15/2008
Invoice 00 -08563
Date�;F;3 Employee§ ar�� ,Descnptione xAmount� Bala'n"ce�Duea
01102!08 Bartow James C. Exec 1 Well Offsite CMP CBC Li id $61.00 $61.00
01/07108 Schalburg, Randy S. Exec 1 Wellness Offsite $61.00 61.00
01/10108 Barlow James C. 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
Schalburg, Randy S. 10 Cities $234.00 $234.00
Treadmill (PFE 165.00 $165.00
Flexibility Check $7.00 $7.00
t'
"ss� s akr� r} rx a c Total
.��r -h�=
r 3a.„v� z ..,4i,. 2 Fs 1kr'"c,�"_ x3",b�- `v r (}.QQ 'e,` 957.1].5
A Total Pa menu.& Balance:Due t
u- k Y
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, Suite 300 Terms
Indianapolis, IN $6204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/3109 MO2 for officer physicals 2,933.00
117108 8524 paym nt fQr officer physicals 495.00
1115108 8563 paymen-t for officer phy 957.00
Total 4,375.00
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.
�f
ALLOWED 20
Public Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46.204
4, 75.00
ON ACCOUNT OF APPROPRIATION FOR
police genera lfund
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
ijin 8502 407-01 2,933, bill(s) is (are) true and correct and that the
1110 8524 407-01 485, 0 materials or services itemized thereon for
Ill() 8563 40 957, 0 which charge is made were ordered and
received except
.Taniiary 17 20 Oa
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
m
W.A Indianapolis, IN 46204
o Carmel Fire Department l CARMEFD
2 Civic Square Terms
F Carmel, IN 46032 Invoice Date 01/07/2008
Invoice 00 -08523
DDate Employee x D`escnptron r Arriount p =a Balance`°Due
01/02/08 Sombke Brad D. Fitness For Du Level 1 $75.00 $75.00
3 'b
s ,��.d»; r aw y`." �+3,N.��,t r�$�;�c<rl n€ e ,.0 u� n JOW' argeS 'm
a d Total.Pa m'ents &sE3alance_fjue >W�, �M °$OOO
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
!1' soribed 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))
Total
I 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. �w
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
DEPT.
r or INVOICE NO. ACCT #/TITLE AMOUNT 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
20
r
g a re
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund