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Home My WebLink About180237 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES 0 CHECK AMOUNT: $5,796.00 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 180237 CHECK DATE: 12/8/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1115 4350900 12047 182.00 OTHER CONT SERVICES 1120 4340701 12048 2,080.00 MEDICAL EXAM FEES 1110 4340701 12049 146.00 MEDICAL EXAM FEES 1120 4340701 12089 2,220.00 MEDICAL EXAM FEES 1110 4340701 12090 368.00 MEDICAL EXAM FEES 1120 4340701 12129 800.00 MEDICAL EXAM FEES INVOICE !o Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 Carmel Clay Communications CARMCOM 31 First Avenue NW Terms Carmel, IN 46032 Invoice Date 11!1812009 m Invoice 00.12047 Date Employee Description Amount Balance Due 11111/09 Case Darc L. Vision Titmus $26.00 $26.00 Audiomet W /Discrimination 65.00 $65.0 0 11/12/09 Earlywine, Elizabeth A. Audiomet W /Discrimination 65.00 $65,0 0 Vision Titmus 26.00 $26.00 Total Charges $182.00 Total Payments Balance Due $0.00 $182.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance Due 15 days from invoice date VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Ste 300 Indianapolis, In 46204 $182.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Clay Communications PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1115 00 -12047 43- 509.00 $182.00 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 Tuesday, December 01, 2009 4*e Director Title Cost distribution ledger classification if claim paid motor 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)) 11/18/09 I 00 -12047 I I $182.00 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 M Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 G Carmel Police Department! CARMEPD Terms 3 Civic Square Carmel, IN 46032 invoice Date 11/24/2009 Invoice 00 -12090 Date Employee Description Amount Balance Due 11/16/09 McNair Harland J. CMP $16.00 $16.00 CBC W /Dill And Plat $13.00 1100 Lipid Panel $16.00 $16.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Quantiferon Tb Gold $50.00 $50.0 0 PSA $35.00 $35.00 Miller Adam C. CMP $16.DC $16.0 0 CBC W /Dill And Plat $13.00 $13.00 Li id Panel $16.00 $16.00 Venipuncture Fee 3.00 HIV 1 &2 $13.00 $13.00 Quantiferon Tb Gold $50.00 $50.00 Myers Brady R. CMP 16.00 16.00 CBC W /Dill And Plat $13.00 $13.00 Lipid Panel 16.00 $16,0 0 Veni uncture Fee 3.00 100 HIV 1 2 $13.00 $13.0 0 Quantiferon Tb Gold WHO $50.0 0 Total Charges $368.00 Total Payments Balance Due $0.00 $368.00 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 ACCOUNTS PAYABLE VOUCHER City Form 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)) 11/24/OS 12090 Davment for officer physicals 68.00 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 1C 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Pu blic Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 368.00 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 12090 407 -01 368.00 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 December 3 20 09 Signature Chief of Olice Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE 4 r'o; Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 1111812009 m Invoice 00 -12049 Date Employee Description Amount Balance Due 11/13/09 Howard Lana M. CMP $16.00 $16.00 CBC W /Dill And Plat $13,00 $13.00 Lipid Panel $16.00 $16.00 Veni uncture Fee $3.00 $3.00 HIV 1 &2 $13.00 $13,00 Quantiferon Tb Gold 50.00 50.00 HB SAb Quantitative Titer $35.00 35.00 Total Charges $146:00 Total Payments Balance Due $0.00 $146.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Prescribed by Slate Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form 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 Medi S Purchase Order No. 324 E. New York Stree S ui te 300 Terms Indianapolis, IN 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 11/18/09 12049 payment for officer physical 146.00 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. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 P ublic Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Tn ianapo is, IN 46204 146.00 ON ACCOUNT OF APPROPRIATION FOR police general fund,, Board Members Pow or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 12049 407 -01 146.00 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 December 2 20 09 Signature Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 Carmel Fire Department CARMEFD Terms F 2 Civic Square Carmel, IN 46032 Invoice Date 11124!2009 m Invoice 00 -12089 Date Employee Description Amount Balance Due 11/16/09 Castor Rick S. Low Back Ortho Eval $80.00 $80.00 Griffin Timothy M. Low Back Ortho Eval $80.00 $80.00 Grimes Jeffrey A. Low Back Ortho Eval $80.00 $80.0 0 Howard Wendell E. Low Back Ortho Eval $BO.00 $80.0 0 Mead Jr. Donald R. Low Back Ortho Eval $80,00 $80.00 Mitchell James C. Low Back Ortho Eval $80.00 $80.0 0 Reippert. Ian T. Low Back Ortho Eval $80,00 $80.00 Robinson Mitchell L. Low Back Ortho Eval $80.00 $80.00 Viehe Richard E. Low Back Ortho Eval $80.00 $80.00 11/17/09 Brisco Michae( D. Low Back Ortho Eval $80.00 $80.00 Freer Keith T. Low Back Ortho Eval $80,00 $80. Kilburn Ro er L. Low Back Ortho Eval $80.00 $80.00 Knott. Bruce A. Low Back Ortho Eval $80.00 $80.00 McNeelv, Michael W. Low Back Ortho Eval $80.00 $80.0 0 Moriartv, John F. Low Back Ortho Eval $80.00 $80.00 Re nolds Shawn J. Low Back Ortho Eval $80.00 $80,0 0 Schooler. Dustin D. Low Back Ortho Eval $80.00 $80.0 0 Weaver Virgil L. Low Back Ortho Eval $80.00 $80.00 11/19109 Bondurant Jeff S. Low Back Ortho Eval 80.00 $80.00 Contino David M. Low Back Ortho Eva! 80.00 $80.0c Cromlich Mark A. Low Back Ortho Eval $80.00 $80.0 0 Holden Adam D. Low Back Ortho Eval $80.00 $80.0 0 HuQhes, Chad L, Low Back Ortho Eval $80.00 $80.0 0 Lux, Michael T. Low Back Ortho Eval $80.00 $80.00 Starr Gre A. Repeat Chest X -Ray $60.00 $60.00 Utzia, Todd T. I Low Back Ortho Eval 80.00 80.00 Youna, Alan R. Low Back Ortho Eval $80.OD $80.0 0 Zeller. Michael J. Low Back Ortho Eval $80.00 80.00 Total Charges $2,220.00 Total Payments Balance Due $0:00 $2,220.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 o Indianapolis, IN 46204 C Carmel Fire Department 1 CARMEFD t 2 Civic Square Terms Carmel, IN 46032 Invoice Date 11/18/2009 m Invoice 00 -12048 Date Employee Description Amount Balance Due' 11/09/09 Anderson D. Cory Low Back Ortho Eval $80.00 $80.00 Johnson Jeremy S. Low Back Ortho Eval 80.00 $80.0 0 Kelsheimer, Troy W. Low Back Ortho Eval $80.00 $80,0 0 Reecer, Jason L. Low Back Ortho Eval $80,00 $80.0 0 Thompson, James L. Low Back Orthe Eval $80.00 $80,OC Tierney, Scott A. Low Back Ortho Eval $80.00 $80.0c Walker Christopher E. Low Back Ortho Eval $80.00 80.00 Webb Greoory A. Low Back Ortho Eval $80.00 $80.D 0 Wendzel Jason D. Low Back Ortho Eval $80.00 $80.0 0 11/10/09 Alverson Jonathon L. Low Back Ortho Eval $80.00 $80.00 Fuchs, Jeff W. Low Back Ortho Eval $80.00 $80.0 Gehlbach, Marc A. Low Back Ortho Eval $80.00 $80.00 Giles William G. Low Back Ortho Eval $80.00 $80.0 0 Holubik Steven W. Low Back Ortho Eval $80.00 80.00 Keaton Anthony R. Low Back Ortho Eval $80.00 $80.00 Price Joseph P. Low Back Ortho Eval $8D.00 $80.0 0 Starr Gregory A. Low Back Ortho Eval 80.00 80.00 Voskuhl. Mark J. Low Back Ortho Eval $80.00 $80.00 11/13/09 Benbow, Kip S. Low Back Ortho Eval $80.00 $80.00 Cummins Frank C. Low Back Ortho Eval S80.00 $80.00 Frost Bruce S. Low Back Ortho Eval $80.00 $80.0 0 Marcum Bradley D. Low Back Ortho Eval $80.00 $80.0 0 Ma rtin, David D. Low Back Ortho Eval $80.00 Martin, Richard A. Low Back Ortho Eval $80.00 $80.00 Weddin ton Kurt L. Low Back Ortho Eval $80.00 $80.00 Young, Andrew S. Low Back Ortho Eval 80.00 80.00 Total Char es g $2,080,00 Total Payments Balance Due $0.00" 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 a Suite 300 X Indianapolis, IN 46204 0 Carmel Fire Department 1 CARMEFD Terms 2 Civic Square Invoice Date 12/02/2009 m Carmel, IN 46032 Invoice 00 -12129 Date Employee Description Amount Balance Due 11/23/09 Collins. Tony A. Low Back Ortho Eval $8000 $80.00 Dorsch James E. Low Back Ortho Eval $80.00 $80.0 0 Drake Carl D. Low Back Ortho Eval $80.00 $80.00 Gipson, Bruce E. Low Back Ortho Eval $80.00 $80.00 Maroon Ernie R. Low Back Ortho Eval 80.00 $80.0c Orange, Douglas D. Low Back Ortho Eval $80.00 $80.00 Reeves Neil P. Low Back Ortho Eval 80.00 $80.00 Workman William J. Low Back Ortho Eval $80.00 $80.00 Wynn Barbara M. Low Back Ortho Eval $80.00 $80.00 11/24/09 Grimes Jeffrey A. Hepatitis B Vaccination #2 $70.00 $70.00 I 'ect'on Fee $1 $10, Total Charges $800.00 Total Payments Balance Due $0.00 $800.00 Please write invoice number on payment check, Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services h IN SUM OF 324 East New York Street, Ste, 300 Indianapolis, IN 46204 $5,100.00 4 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 12048 43- 407.01 $2,080.00 1 hereby certify that the attached invoice(s), or 1 120 12089 43 407.01 $2,220.00 bill(s) is (are) true and correct and that the 1120 12129 43- 407.01 $800.00 materials or services itemized thereon for which charge is made were ordered and received except m� Fire Chief Title Cost distribution ledger classification if claim paid motor 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)) 12048 $2,080.00 12089 $2,220.00 12129 $800.00 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