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Home My WebLink About203136 10/25/2011 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: $3,567.24 INDIANAPOLIS IN 46204 CHECK NUMBER: 203136 CHECK DATE: 10/25/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 15956 65.00 MEDICAL FEES 1120 4340701 24216 16114 424.26 ANNUAL EXAMS 1125 4340700 16115 25.00 MEDICAL FEES 1120 4340701 24216 16179 1,819.44 ANNUAL EXAMS 1125 4340700 16180 65.00 MEDICAL FEES 1110 4340701 16227 268.54 MEDICAL EXAM FEES 1110 4340701 27771 16227 900.00 PSYCH PHYSICAL FOR INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 o Carmel Clay Parks Recreation CARMELPARK 1411E 116th Street Terms Carmel, IN 46032 Invoice Date 09/08/2011 m Invoice 00 -15956 Date Employee Description Amount Balance Due 09/02/11 Ra endan Shru hee He atitis B Vaccination #1 $65.00 $65.0 0 Infection Fee $0.00 $0.00 Total Charges $65.00 Total Payments &Balance Due $0.00 $65.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date Purchase Description n e S P.O.# PorF G.L.# p 13t 700 Budget Line Descr S p 1 Purchaser ate_ Q�;� 5 yy 1 Approval Date j 1 Q1 li INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 a) x Indianapolis, IN 46204 G Carmel Clay Parks Recreation CARMELPARK 1411E 116th Street Terms Carmel, IN 46032 Invoice Date 09/28/2011 m Invoice 00 -16115 Date Employee Description Amount Balance Due 09/22/11 Edwards Michael HB SAb Quantitative Titer 25.00 $25.00 Veni uncture $0.00 $0.00 Total Charges $25.00 Total Payments &Balance Due $0.00 1 $25.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from Invoice date r i SEP 3 0 2011 Purchase Description P.O.# PorF G.L. 10 -000 Budget n Line Descr l /i P S Purchaser dte Approval Date 10114/ ____W INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 w Indianapolis, IN 46204 C Carmel Clay Parks Recreation CARMELPARK t— Terms 1411 E 116th Street Carmel, IN 46032 Invoice Date 10/06/2011 CD Invoice 00 -16180 Date Employee Description Amount Balance Due 09/27/11 Edwards Michael In ection Fee $0.00 $0.00 He atitis B Vacc Booster $65.00 $65.00 Total Charges $65.00 Total Payments Balance Due $0.00 1 $65.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date Purchase f CC t S CL Description cU P.O.# f PorF G.L.# Z -5 L 4 1 o ou c" �(3'�0'7o U Budget e d t c� c_ F�� S Line Descr q; Purchaser y t Approval_ Date=0 I( T 1 120 i� ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 00350364 Public Safety Medical Services Terms 324 E. New York Street, Ste 300 Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 9/8/11 15956 Medical fees 65.00 9/28/11 16115 Medical fees 25.00 10/6/11 16180 Medical fees 65.00 Total 155.00 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 1 20 Clerk- Treasurer Voucher No. Warrant No, 00350364 Public Safety Medical Services Allowed 20 324 E. New York Street, Ste 300 Indianapolis, IN 46204 In Sum of 155.00 ON ACCOUNT OF APPROPRIATION FOR 101 -General Fund PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members Dept 1081 -99 15956 4340700 65.00 1 hereby certify that the attached invoice(s), or 1125 16115 4340700 25.00 bill(s) is (are) true and correct and that the 1125 16180 4340700 65.00 materials or services itemized thereon for which charge is made were ordered and received except 20 -Oct 2011 Signature 155.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE 0 Public Safety Medical Services 324 E. New York Street Suite 300 W Indianapolis, IN 46204 0 Carmel Fire Department I CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 09/28/2011 Invoice 00-16114 Description Amount Balance Due t 3 a c NA a r c 4k. CCS 4-Week (Referrah WOO 0. 0 0; Hu:rnisor" Bhallp. OnMed $0.00 50,00 'Heap, R,sk A rai"�! Wotivatlon $000 $0.00 Respirator,Modical Review $16.32 $16.32 Physical Exam 599.95 $99.961 Tw"):jry it So S 156.00 S 156.00) scular Stis-ntih EVJLI'30��,' I L 42 6.52 Flexibility Tpsi 10 Zti q, 1 0 '2! d Boo\; Fat Tes! BIA (Bic Imp Anal S14.28 S14.281 Waistiljlr, Ratic 1 1;1 3, Q 6 $3,0 Vi HI VVT BP r' R S0,00 $0.00 Vision ACUitV $26.52 $26,52 T PFT Pj.J1r!10fMfV FUndiori Test 533,66 $33.66 Audiornetry $14,28 1 $14.28 i. EKG VV! lnteiT! 1 $20.4 $20.401 Unnalysis Dipstick 3.06 3.OF Total 9" Char $424.26 Total Payments Balance DL7,-+ s0.00 1 724 �26 Please v, im number on payment check. ')jr 91 -:ederal -Employer identification Nurnbef is 35..207, 7 Balance due 1 days from Invoice date INVOICE o Public Safety Medical Services 324 E. New York Street Suite 300 Indianapolis, IN 46204 Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 1010612011 Invoice 00-16179 a E mv ve e Desonr.)finn Amount B a la n C e ED,, r rnorna...s., OnMed Procirgm $0.00 F Health Risk Appraisal 'Motivation} $0,00 $0.00 Respirator/mg(ficif Review S16,32 516.32 Compre.herisive Ph"sical Exam 99.96 $99,96 d MuNcular Sir-n(Ith Endurance T(nl S 2 6..5 Jes! $1,1 $10.201 S'4 .2F $3 0 Treadmill StuOrnax. 56 Chest -Ray PAP AT (Djqitah �171 $6 1,20 Vital-Sions HT WT BP P R SO 0 1 IRL00 Vision -iL-I-Ial- $26.52 $26.52 PFT Pulmonary F -i nction Test $33,66 $3 Audiornetry $14. ^6 $'14.28 EKG W! Inter,- $20.40 $20.40 Urinalysis Dipstick S3.06 -Ua2 Vif,-h�., Richard E. OnMod Proaram Sow 50.00 Health Risk AgLvaisal (Motivation) $Q.00 i 0.00 Res p;rator/Medical Review S16.3 $1632 Comprehent.0yu Phyjiigal E gT 99.96 $99.96 MUSCUlaf SWgLqcj1L) Endurance I est $26.52 _,$26.52 S 2(' $1020 Inc irny) Lma!0 53.06 S106 T readmifl subma) $1,J. 0 $1 56.00 Ches' X-Rav PAjLA1 'Didtal) SR, 1. 20' $61.20 Vital Signs HT V41 QP P R $0.00 $0.00 Vision Acuity $26.52 $26.52 pri P ornonary 1-unction Test $33 ri- $33.66 Audiornewy S 1 4.2 8 14.281 EKG vV! interr 5'1 $3.06 $3.0 To 0o H(> Zift Rik N it (Mativ, .50,0(,) Z) 11 Review 1 16 32 Physical Exam. subm""IX :'1 56.00 MUSCUlar S.trenqlh En(iurarv:e. T. F) Fi7exi TC 4. 1 0 .2 P, 2, I est BIA Imp Anaio W 3. 3, C; C S3.06 Wal- Mns HT WT BP P R 00 Vision Acuity 526.52 $26.52 _E 6 nongy �Rg-fign Te 3:3 G. c20.10 UMAJ INVOICE F 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Fire Department/ CARMEFD F— Terms 2 Civic Square Carmel, IN 46032 Invoice Date 10/06/2011 m Invoice 00 -16179 Date Employee Description Amount Balance Due Urinalysis Di stick $3.06 $3.06 Orange, Douglas D. OnMed Pro ram $0.00 $0.001 Health Risk A raisal Motivation 0.00 $0.0 0 Respirator/Medical R vi w $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 Muscular Strength Endurance Test $26.52 $26.52 Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal $14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiornetry $14.28 $14.28 EKG W/ Intern $20.40 $20.40 U rinalysi s Di 3 6 Total Charges $1,819.44 Total Payments Balance Due $0.00 $1,819.44 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from Invoice date 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)) 16114 $424.26 16179 $1,819.44 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 N ALLOWED 20 Public Safety Medical Services IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $2,243.70 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department F PO# Dept. INVOICE NO. ACCT #/TITLE I AMOUNT Board Members 24216 16114 43- 407.01 j $424.26 I hereby certify that the attached invoice(s), or 24216 16179 43- 407.01 $1,819.44 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 G Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE to- Public Safety Medical Services 324 E. New York Street E Suite 300 m of Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 10/13/2011 m Invoice 00 -16227 Date Employee Description Amount Balance Due 10/07/11 Bailey, Vicki L. Quantiferon Tb Blood 51.00 $51.00 Veni uncture $3.06 $3.06 Boles Elizabeth L. Quantiferon Tb Blood 51.00 $51.00 Veni uncture 3.06 $3.06 Bricker Kristy A. Quantiferon Tb Blood 51.00 $51.0 0 Veni uncture $3.06 $3.06 Gauthier Edward B. Quantiferon Tb Blood 51.00 $51.00 CMP (Como Metabolic Panel 19.52 $19.52 CBC (Comp Blood Count 17.68 $17.68 Li id Panel Blood 20.74 $20.74 Venbuncture $3.06 HIV 1 2 Blood $13.26 $13.26 Graham Bruce A. Quantiferon Tb Blood $51.00 $51.00 CMP (Comp Metabolic Panel 19.52 $19.52 CBC (Comp Blood Count $17.68 $17.68 Lipid Panel Blood $20.74 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood 13.26 $13.26 PSA Prostate S ecific A Blood 35.70 $35.70 Green. Timothy J. Quantiferon Tb Blood 51.00 $51.00 CMP Com Metabolic Panel 19.52 $19.52 CBC Com Blood Count 17.68 $17.68 Lbi Panel I $20,74 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood $13.26 1 $13.26 PSA Prostate Specific A Blood 35.70 $35.70 Jellison. Ryan D. Quantiferon Tb Blood 51.00 $51.00 CMP (Como Metabolic Panel 19.52 $19.52 CBC (Comp Blood Count 17.68 $17.68 Lipid Panel Blood 20.74 $20.74 Veni uncture $3.06 $3.06 PSA Prostate Specific A Blood 35.70 $35.70 Klein Marc A. Quantifer on Tb Blood 51.00 $51.0 0 CMP Com Metabolic Panel 19.52 $19.52 CBC o Blood ou nt) $17.68 $17.681 Lipid Panel Blood $20.74 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood $13.26 $13.26 Miller, Adam C. CMP Com p Metabolic Panel 19.52 $19.52 CBC (Comp Blood Count 17.68 $17.68 Lipid Panel Blood 20.74 $20.741 Veni uncture $3.06 $3.06 HIV 1 2 Blood 13.26 $13.26 Q uantiferon Tb Blood 51.00 $51.0 0 Pirics John D. Quantiferon Tb Blood 51.00 $51.0 0 CMP fComp Metabolic Panel 19.52 $19.52 INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 10/13/2011 m Invoice 00 -16227 Date Employee Description Amount Balance Due CBC Com Blood Count 17.68 $17.68 Lipid Panel Blood 20.74 $20.741 Veni uncture 3.06 3.06 HIV 1 2 Blood) 1 PSA Prostate Specific Ag Blood $35.70 $35.70 Total Charges $1,168.54 Total Payments Balance Due $0.00 1 $1,168.54 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 C 0 INDIANA RETAIL TAX EXEMPT PAGE ity Carme CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 2m9 35- 60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE. FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. t VENDOR NO. DESCRIPTION 4093f�9 9 Public 80 Modleml ftrwlcoo Catol Police Dopatmort VENDOR SHIP 3 CIVIC squm 3N E. NGvj Yo rk Stmt, Salto 300 TO Camol, IN Indlaa2p®lls, IN 4M (397) 671 CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 63- 107.09 9 Each psydi physicel for applicant $000.00 $900.00 Stab Total: $000.00 4 Adam Dovon ort r 0 Send Invoice To: N C &mel Pcllco Dopwtmon,t Attu: TGmsa Andaman 3 CIVIC squaw Camel, IN 2- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT Camel Police Dept. PAYMENT A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE APART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFYD)AT IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRI TIONISUFFICIENT TO PAY FOR THE ABOVE ORDER. /j C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY /I PURCHASE ORDER NUMBER MUST APPEAR ON ALL gay SHIPPING LABELS. leis of f Pol ice THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE V AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK TREASURER DOCUMENT CONTROL NO-27771 A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO. WARRANT NO. ALLOWED 20 IN THE SUM OF ell ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. 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 Signature Title Cost distribution ledger classification if claim paid rnotor 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)) 10/13/11 16227 officer physicals $268.54 10/13/11 16227 officer physicals $900.00 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 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $1,168.54 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1110 16227 43- 407.01 $268.54 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 27771 16227 43- 407.01 $900.00 materials or services itemized thereon for which charge is made were ordered and received except Thursday, October 20, 2011 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund