The URL can be used to link to this page

Home My WebLink About204067 11/22/2011 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: $11,606.96 INDIANAPOLIS IN 46204 CHECK NUMBER: 204067 CHECK DATE: 11/22/2011 DEPARTMENT ACCOUNT PO NUMBER INVO NUMBER AMOUNT DESCRIPTION 1120 4340701 10396 2,500.00 MEDICAL EXAM FEES 1120 4340701 16337 1,423.00 MEDICAL EXAM FEES 1120 4340701 16400 397.74 MEDICAL EXAM FEES 1110 4340701 16401 1,582.46 MEDICAL EXAM FEES 1120 4340701 16460 175.00 MEDICAL EXAM FEES 1110 4340701 16462 5,463.76 MEDICAL EXAM FEES 1081 4340700 16496 65.00 MEDICAL FEES INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 a) a: Indianapolis, IN 46204 o Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 11/04/2011 m Invoice 00 -16400 Date Employee Description Amount Balance Due 10/26/11 Mason Bryan L. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Ph sical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 Flexibility Test $10.20 $10.2 0 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 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Total Charges $397.74 Total Payments Balance Due $0.00 $397.74 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 INVOICE 0 Public Safety Medical Services w 324 E. New York Street E Suite 300 IY Indianapolis, IN 46204 C Carmel Fire Department CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 11/10/2011 m Invoice 00 -16460 Date Employee Description Amount Balance Due 1 10/31/111 Giles. William G. Fitness For Duty Exam Initial Level 2 $175.00 $175.00 Total Charges $175.00 Total Payments Balance Due $0.00 $175.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 m x Indianapolis, IN 46204 C Carmel Fire Department CARMEFD f 2 Civic Square Terms Carmel, IN 46032 Invoice Date 10/31/2011 m Invoice 00 -16337 Date Employee Description Amount Balance Due 08/01/11 Edwards Steven L. CCS 4 -Week Results $79.00 $79.00 Gipson Bruce E. CCS 4 -Week Results 79.00 $79.0 0 Stress Echo CCS $375.00 $375.00 08/16/11 DeCrastos Richard A. Stress Echo CCS 375.00 $375.00 08/18/11 Platt Jace P. CCS 4 -Week Results 79.00 $79.00 Stress Echo CCS $375.00 $375.00 10/17/11 Mason Bryan L. 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 Total Charges $1,423.00 Total Payments Balance Due $0.00 $1,423.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date Public Safety Medical Services, Inc. 09AVORCE 324 E. N ew York Suite 300 Invoice Number: 11-10396 Indianapolis, IN 46204 Invoice Date: Nov 10, 2011 TIN 35-2079797 Page: Voice: 1-317-972-1180 Fax: 1-317-972-1190 Carmel Fire Department 2 Civic Square Carmel, IN 46032 aii6rn a Customer ID i YM CARMEFC Net 30 Days Z7- !pp!,Qg,m Ip e- Courier 12/10/11 U Ate f inal billing for Work Performance 2,500.001 Evaluations Subtotal 2,500.00 Sales Tax Total Invoice Amount 2,500.00 Ch eck /Cred Memo N o: Payment/Credit Applied T i i 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)) 16460 $175.00 10396 ENCUMBRANCE $2,500.00 16400 I I $397.74 16337 I I $1,423.00 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 IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $4,495.74 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 16460 43- 407.01 $175.00 rF ereby certify that the attached invoice(s), or 1120 10396 43- 407.01 $2,500.00 bill(s) is (are) true and correct and that the 1120 I 16400 I 43- 407.01 I $397.74 materials or services itemized thereon for 1120 I 16337 I 43- 407.01 I $1,423.00 which charge is made were ordered and received except NOV 2 1 2011 e Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE o Public Safety Medical Services 324 E. New York Street Suite 300 Indianapolis, IN 46204 Carmel Clay Parks Recreation CARMELPARK 1411 E 116th Street Terms Carmel, IN 46032 Invoice Date 11110/2011 Invoice 00-16496 E mployee Datb� 11/04111 Raiendan, Shruphee Heoatitis B Vaccination #2 $65.00 $65.0 Iniection Fee $0.00 $0.00 465 nce, Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 B due 15 days from invoice date Purchase Description P.O. P or F o G.L. Budget Line Descr D-t 'r 0 1-0 t D Purchaser Date— i—q ItCq Approval NOV 1 4 1011 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 11/10/11 16496 Medical fees 65.00 Total 65.00 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. 00350364 Public Safety Medical Services Allowed 20 324 E. New York Street, Ste 300 Indianapolis, IN 46204 In Sum of 65.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1081 -99 16496 4340700 65.00 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 17 -Nov 2011 Signature 65.00 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 E Suite 300 W Indianapolis, IN 46204 O Carmel Police Department CARMEPD F' 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11/04/2011 1:0 Invoice 00 -16401 Date Employee Description Amount Balance Due 10/24/11 Cash. Steven H. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 WaisUHi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test 36.72 $36.72 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT Pulmonary Function T t Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Hep B Titer SAb Quantitative Blood 35.70 $35.70 Veni uncture $3.06 $3.06 Gauthier Edward B. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Flexibility Test $10.20 $10.201 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 W i Hi Ratio Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test $36.72 $36.72 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 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 Leach Aaron M. OnMed Program $0.00 $0.00 Health Risk Aopraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comp rehensive Physical E Flexibility Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal $14.28 $14.28 WaisUHi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test 36.72 $36.72 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 Audiometry 14.28 $14.28 EKG W/ Intero $20.40 $20.40 Urinal sis Di stick $3.06 $3.06 INVOICE Fes— Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 Carmel Police Department CARMEPD E— Terms 3 Civic Square Carmel, IN 46032 Invoice Date 11/0412011 m Invoice 00 -16401 Date Employee Description Amount Balance Due 10/27/11 M ers Bradv R. Quantiferon Tb Blood 51.00 $51.00 CMP Com Metabolic Panel 19.52 $19.52 CBC (Como Blood Count 17.68 $17.68 Linid Panel (Blood) 0.74 $20.74 Veni uncture $3.06 $3.06 HIV 1 2 Blood $13.26 $13.26 10/28/11 Horner, Jeffrev J. 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 Venirounc ture $3.06 $3.06 HIV 1 2 Blood 13.26 $13.26 Total Charges $1,582.46 Total Payments &Balance Due $0.00 $1,582.46 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 E Suite 300 .W Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11/10/2011 m Invoice 00 -16462 Date Employee Description Amount Balance Due 10/31/11 Barlow. Cody J. 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 Hen B Titer SAb Quantitative Blood 35.70 $35.70 Carey. Luckie A. OnMed Program $0.00 $0.00 Health Risk Aooraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 C omprehensive Physical Exam 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 Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test 36.72 $36.72 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 Audiometry 14.28 $14.28 EKG W/ Intero $20.40 $20.4 0 Urinalysis Di stick $3.06 $3.06 Ouant 1. Veni uncture $0.00 $0.00 In ection Fee $10.20 $10.20 Td Tetanus Diphtheria) Vacc $20.40 $20.40 Clark Sr. Todd C. Quantiferon Tb Blood 51.00 $51.0 0 CMP (Comp Metabolic Panel 19.52 $19.52 CBC (Comp Blood Count 17.68 $17.68 Li id Panel Blood 20.74 $20.74 Veni uncture $3.06 $3.0 6 HIV 1 2 Blood 13.26 $13.26 Herron James C. OnMed Pro ram $0.00 $0.00 Health Risk Aopraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16. Com rehensive Physical Exam $99.96 $99.96 FlexibilitV Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test 36.72 $36.72 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 Audiometry 14.28 $14.28 EKG W/ Inter 20.40 20.40 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11/10/2011 m Invoice 00 -16462 Date Employee Description Amount Balance Due Urinalysis Di stick $3.06 $3.06 Horner Jeffrey J. OnMed Pro ram $0.00 $0.001 Health Risk A raisal Motivation 0.00 $0.00 Respirator/Medical evi 1 1 Comprehensive Physical Exam $99.96 $99.96 FlexibilitV Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.0 0 Tonomet Glaucoma Test 36.72 $36.72 Vital Signs HT WT BP P R $0.00 $0.0 0 Vision Acuity 26.52 $26.52 PFT Pulmonary Function Test $33.661 Audiornetry $14.28 $14.28 EKG W Inter 20.40 $20.4 0 U rinalysis Dipstick Jellison Ryan D. Urinalysis Dipstick $3.06 $3.06 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Flexibilitv Test $10.20 $10.20 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test 36.72 $36.72 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Acuity 2 2 $2 6.52 PFT Pulmonary Function Test $33.66 $33.66 Audiornetry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Me er. Ryan J. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.321 Comprehensive Physical Exam $99.96 $99.96 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 u of r n- Tb BI 1 Veni uncture $0.00 $0.00 Injection Fee $10.20 $10.20 Td Tetanus Diphtheria) Vacc $20.40 $20.4 0 Tonomet Glaucoma Test 36.72 $36.72 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 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Police Department CARMEPD H 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11/10/2011 m Invoice 00 -16462 Date Employee Description Amount Balance Due Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 11/01/11 Kinkade Matthew P. Quantiferon Tb Blood 51.00 $51.0 0 CMP (Comp Metabolic Panel 19.52 $19.52 CBC (Como 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 11/03/11 Gilbert William J. Quantiferon Tb Blood 51.00 $51.00 P (Como Metabolic Panel) 1 9. 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 11/04/11 1 Barlow Cody J. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 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 Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test $36.72 $36.72 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Acuity $26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Di stick $3.06 $3.06 Clark Sr. Todd C. Comprehensive Physical Exam $99.96 $99.96 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 Treadmill Submax $156.00 $156.0 Tonometr Glaucoma Test $36.72 $36.72 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 Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.4 0 Urinalysis Dipstick $3.06 $3.06 In ection Fee $10.20 $10.2 0 Td Tetanus Diphtheria) Vacc $20.40 $20.4 0 OnMed Pro ram $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 G Carmel Police Department CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 11(10/2011 m Invoice 00 -16462 Date Employee Description Amount Balance Due Respirator/Medical Review $16.32 $16.32 Graham Bruce A. OnMed Program $0.00 $0.001 Health Risk Appraisal Motivation 0.00 $0.00 ResoiratorlMedical Review 1 1 Comprehensive Physical Exam $99.96 $99.96 Tonomet Glaucoma Test $36.72 $36.72 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 Audiometry 14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 In ection Fee $10.20 $10.201 Td Tetanus Di htheria Vacc $20.40 $20.4 0 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Wi Hju R .0 6 Kinkade Matthew P. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Ph sical Exam $99.96 $99.96 Flexibility Test $10.20 $10.2 0 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 Waist/Hi Ratio $3.06 $3.06 Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test 36.72 $36.72 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 26.52 $26.52 PFT P I n Function T t $33.66 $33.66 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinal sis Dipstick $3.06 $3.06 In ection Fee $10.20 $10.20 Td Tetanus Diphtheria) Vacc $20.40 20.40 Myers. Brady R. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 Treadmill Submax $156.00 $156.00 Tonometr Glaucoma Test 36.72 $36.72 Vital Sians -HT WTBPPR $0.00 $0 Vision Acuity $26.52 $26.52 PFT Pulmonary Function Test $33.66 $33.66 Audiometry 14.28 14.28 EKG W/ Inter $20.40 20.40 Urinal sis Dipstick 3.06 $3.06 Body Fat Test BIA Bio -Elec Imp Anal 14.28 $14.28 WaisUft Ratio $3.06 $3.06 INVOICE ho- Public Safety Medical Services 324 E. New York Street E Suite 300 aD W Indianapolis, IN 46204 G Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11/10/2011 m Invoice 00 -16462 Date Employee Description Amount Balance Due Zellers Timothy And A. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.32 $16.32 Comprehensive Physical Exam $99.96 $99.96 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 Treadmill Submax $156.00 $156.00 Tonomet Glaucoma Test 36.72 $36.721 Vital Signs HT WT BP P R $0.00 $0.00 Vis ion AGuit PFT Pulmonary Function Test $33.66 $33.66 Audiometry $14.28 $14.28 EKG W/ Interp $20.40 $20.40 Urinalysis Dipstick $3.06 $3.06 Hep B Titer SAb Quantitative Blood 35.70 $35.70 Veni uncture $3.06 $3.06 In ection Fee $10.20 $10.2 0 Td Tetanus Diphtheria) Vacc 20.40 $20.4 0 Total Charges $5,463.76 Total Payments Balance Due $0.00 $5,463.76 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)) 11/04/11 16401 officer physicals $1,582.46 11/10/11 16462 officer physicals $5,463.76 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 $7,046.22 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 16401 43- 407.01 $1,582.46 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 16462 43- 407.01 $5,463.76 materials or services itemized thereon for which charge is made were ordered and received except Wednesday, November 16, 2011 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund