155474 01/10/2008 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: $3,857.00
INDIANAPOLIS IN 46204 CHECK NUMBER: 155474
CHECK DATE: 1/10/2008
DEP ARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 00 -08427 2,402.00 MEDICAL EXAM FEES
1110 4340701 00 -08468 1,455.00 MEDICAL EXAM FEES
I
I
INVOICE
V
Public Safety Medical Services
324 E. New York Street
r
E Suite 300
v
CE Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 1211812007
m Invoice 00 -08468
Date Employee Description Amount Balance Due
12/06/07 Fisher, Charles B. Exec 1 (Wellness) Offsite $0.00 50.00
12/10107 Miller. Adam C. Exec 1 (Wellness) Offsite $0.00 $0.00
12/11/07 Me er. Ryan J. 10 Cities $291.00 $291.00
Treadmill (PFE) $164.00 $164.00
Flexibility Check $7.00 $7.00
Waist/Hip Ratio s0.00 $0.00
12/12/07 Fisher, Charles B. 10 Cities $291.00 $291.00
Treadmill (PFE) 164.00 5164.00
Flexibility Check $7.00 $7.00
Muscle Strength Endurance $23.00 $23.001
W i Hi Ratio $0.00 0.00
Havmaker. William E. 10 Cities $291.00 $29100
Treadmill (PFE) $164.00 $164.00
Bodv Fat Check Bod Pod $23.00 $23.00
FlexibiiitV Check 57.00 $7.00
Muscle Strength Endurance $23.00 $23.00
Waist /Hi Ratio $0.00 $0.00
Kinkade. Matthew P. Exec i (Wellness) Offsite $0.00 50.00
Total Charges $1,455.00
Total Payments 8 Balance Due $0.00 $1,455.00
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
m Indianapolis, IN 46204
0 Carmel Police Department 1 CARMEPD Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 12/11/2007
a3 Invoice 00 -08427
Date Employee Description Amount Balance Due
12/03/07 Zellers, Nancy L. 10 Cities $291.00 $291.00
Treadmill (PFE) 5164.00 $164.00
Flexibility Check $7.00 S7.00
Waist/Hip Ratio $0.00 $0.00
12104/07 Gilbert. William J. Exec 1 Wellness Offsite $0.00 $0,00
Jellison. Rvan D. Exec 1 (Wellness) Offsite $0.00 $0.00
12/05/07 Carey, Luckie A. 10 Cities $291.00 $291.00
Treadmill (PFE $164.00 5164.00
Body Fat Check Bod Pod 2100 523.00
Flexibility Check $7.00 $7.001
Waist/Hip Ratio $0.00 S0,001
Matthews. Daniel M. 10 Cities S291.00 5291.00
Treadmill (PFE) 5164.00 $164.00
Bcdv Fat Check Bod Pod 523.00 $23.00
Flexibility Check 57.00 $7.00
WaisUHi Ratio $0.00 $0.00
12/06107 Bickel. Joseph E. 10 Cities $291.00 5291.00
Treadmill (PFE) $164.00 $164.00
Body Fat Check Bod Pod 523.00 $23.0 0
Flexibility Check $7.00 $7.00
Muscle Strength Endurance $23.00 $23.00
Waist /Hi Ratio $0.00 $0.00
Fisher Ben'amin Exec 1 Wellness Offsite SO.00 $0.00
12/07/07 Clark. Todd C. 10 Cities $291,00 $291.00
Treadmill (PFE) 5164.00 $164.00
FlexibilitV Check $7.00 1 $7.00
Waist/Hip Ratio S0.00 50.00
Total Charges $2.402.00
Total Payments Balance Due $0.00 S2,402.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
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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 St
Suite 300 Terms
Indpls, IN 46204
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/11/07 00 -08427 department physicals officers; Zellers, Gilbert 2 402.00
Jellison, Carey, Matthews, Bickel, Clark
12/18/07 00 -08468 department physicals officers; Fisher, Miller Meyer 1 455.00
Haymaker,
Total 3,857.00
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
Public Safety Medical Services
324 E. New York St.
IN SUM OF
Suite 300
Tnd pls IN 46204
3,85
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 00 -08427 407 -01 2 ,40 2 -00 bill(s) is (are) true and correct and that the
1110 00 -08468 407 -01 1,455.00 materials or services itemized thereon for
which charge is made were ordered and
received except
January 3 20 08
S i u r
A cting TMet of Police
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund