179381 11/11/2009 CITY 01= CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $5,817.00
%o CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 179381
CHECK DATE: 11/11/2009
DEPARTMENT ACCOUNT PO NU MBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4350900 11924 1,976.00 OTHER CONT SERVICES
1.120 4340701 11925 1,400.00 MEDICAL EXAM FEES
1110 4340701 11926 1,104.00 MEDICAL EXAM FEES
1115 4350900 11968 707.00 OTHER CONT SERVICES
1110 4340701 11970 630.00 MEDICAL EXAM FEES
A
INVOICE
t o Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Police Department I CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 10/28/2009
m Invoice 00.11926
Date Employee Description Amount Balance Due
10/19/09 Carey, Luckie A. CMP $16.00 $16.00
CBC WIDiff And Plat $13.00 $13.0 0
Lipid Panel $16.00 $16.0 0
Veni uncture Fee $3.00 $3.0 0
PSA $35.OD $35.001
Quantiferon Tb Gold 50.00 $50.00
HB SAb Quantitative Titer $35.00 $35.00
Matthews Daniel M. CMP $16.00 16.00
CBC WIDiff And Plat $13.00 $13,D 0
Li id Panel $16.00 $16.00
V Fee $3.00 $3.001
HIV 1 2 $13.00 $13.00
Quantiferon Tb Gold $50.00 $50.00
HB SAb Quantitative Titer $35.00 $35.0 0
Meyer Ryan J. CMP $16.00 $16.00
CBC WIDiff And Plat $13.00 $13.00
Lipid Panel $16,DO $16.0 0
Veni uncture Fee $3.00 $3.00
HIV 1 2 13.00 $13.0 0
HB SAb Quantitative Titer $35.00 $35,00
Q uantiferon -Tb Gold 50.00- 50.00
10/23/09 Hucihes. Crystal Indiana Police /Fire PERF $175.DO $175.00
C hart Review/Compl $52-00 $52.0 0
Applicant Health Screen PERF $101.00 $101.00
Drug Screen 8 GC /MS W /MRO $70.00 $70.00
Chest PA/LAT $60.00 $60.00
Vital Signs HT WT BP P R $7.00 $7.00
Vision Titmus $26.00 126.D 0
Color Vision Ishihara 26.00 $26.0 0
PFT W/Interp $33,00 $33.0 0
Audiornetry $14.00 $14.00
L ECG W/ Inter 20.00 $20.00
Urinalysis Di stick $3.00 $3.00
Tonornetry $36.00 $36
Tb Review Non PSIVIS $0.0Q .0
Thomas Richard E. Repeat Glucose Fasting $21.00 $21.00
Total Charges $1,104.00
Total Payments Balance Due $0.00 $1,104.00;
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 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 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/28/09 11926 payment for officer phy1cals and applicant physicals 1,104.00
Total
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
Indianapolis, IN 46204
1,104.00
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 11926 407 -01 I ,104.00 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
November 6 20 09
Signature
Chief of POlice
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
s INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
m Indianapolis, IN 46204
0 Carmel Police Department CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 11104/2009
m Invoice 00 -11970
Date Employee Description Amount Balance Due
10/29/09 Grimes Eric R. Indiana Police /Fire PERF $175.00 $175.00
Chart Review/Completion $52.00 $52.00
Chest PA/LAT $60.00 $60.0 0
Tb Skin Test $7.00 $7.00
Applicant Health Screen PERF $101.00 $101.00
Drun Screen 8 GC /MS W /MRO $70.00 $70.00
Vital Si ns HT WT BP P R $7.00 $7.00
Vision Titmus $26.00 $26.0 0
Color Vision Ishihara 26.00 $26.00
PFT Wllnter 33.00 $33.00
Audiom t 14.0 $14.0
EGG W1 Interp $20.00 $20.00
Urinalysis Dipstick $3.00 $3.00
Tonomet 36.00 $36.00
Total Charges $630.00
Total Payments Balance Due $0,00 $630.00
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 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/4/09 11970 pa)ment for pbysiral for applicant 630-00
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
VOU ,-HER NO. WARRANT NO.
ALLOWED 20
P ublic Safety Medical Servcices IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
f 630.00
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 11970 407 -01 630.00 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
November 6 20 09
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
1
INVOICE
t o Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
o Carmel Clay Communications 1 CARMCOM
31 First Avenue NW Terms
Carmel, IN 46032 invoice Date 10/28/2009
M Invoice 00 -11924
Date Employee Description Amount Balance Due
10/20/09 Collins Ashley M. Vision Titmus $26.00 $26.00
Offsite Administrative Fee $5.00 $5.00
Gordon Peggy D. Vision Titmus $26.00 $26.00
Offsite Administrative Fee $5.00 $5.00
Paulin Kent E. Vision Titmus $26.00 $26.00
Offsite Administrative Fee $5.00 $5.00
Philli s Kerry N. Vision Titmus $26.00 $26,00
Offsite Administrative Fes $5.00 5.00
Reddick Joshua P. Vision Titmus $26.00 $26.00
Mite Administrative Fee 5.00 5.00
Stilts, Dennis Vision Titmus 2. 0 $2 6.00
Offsite Administrative Fee $5.00 $5.00
Tyler. Janice Y. Vision Titmus $26.00 $26.00
Offsite Administrative Fee $5.00 $5.00
Wolfe Lin L. Vision Titmus $26.00 $26.0 0
Offsite Administrative Fee $5.00 $5.00
10/21/09 Amone Janet R. Vision Titmus 126.00 $26.0 0
Offsite Administrative Fee $5.00 $5.00
Audiometry W /Discrimination $65.00 $65.0 0
Bedell Gregory A. Audiometry W /Discrimination 65.00 $65.00
Vision Titmus $26.00 26.00
Offsite Administrative Fee 15.00 $5.00
Cr i Ben'amin D, Audiametry W Di rim in do 5 .QQ $65.
Vision Titmus $26.00 $26.00
Offsite Administrative Fee $5.00 $5.00
Frv, Sherry D. Audiomet W/D iscrimi nation $65.00 65.00
Vision Titmus $26.00 $26.0 0
Offsite Administrative Fee $5.00 $5.00
Layton, Matthew E. Audiomet W /Discrimination $65.DO $65,0 0
Vision Titmus $26.00 $26,00
Offsite Administrative Fee $5,00 $5.00
Luckoski Todd C. Audiomet W /Discrimination $65.00 $65.00
Vision Titmus $26.00 $26.0 0
Qffs Administrative Fee $5.00 $5.00
Smith Brian M. A di m iscriminati n S65.00 $6 5.00
Vision Titmus $26.00 $26.00
Offsite Administrative Fee $5.00 $5.00
W ler Kay E. Audiometry W /Discrimination $65.00 $65.00
Vision Titmus $26.00 $26.00
Offsite Administrative Fes $5.00 $5.00
10/22/09 Akers William P. Audiomet W /Discrimination $65.00 65.00
Vision Titmus $26.00 $26.0 0
Offsite Administrative Fee $5.00 $5.00
Callahan Nicholas P. Audiometry W /Discrimination $65.00 $65.0 0
Vision Titmus 26.00 26.00
Offsite Administrative Fee $5.00 s5m
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
M Indianapolis, IN 46204
o Carmel Clay Communications I CARMCOM
31 First Avenue NW Terms
Carmel, IN 46032 Invoice Date 10128/2009
m Invoice 00 -11924
Date Employee Description Amount Balance Due
Heinzman Jr. David M. Audiometry WlDiscrimination $65.00 $65.00
Vision Titmus $26.00 $26.00
Offsite Administrative Fee $5.00 $5.00
Jo kantas, John M. A di t W D' cri in tin $65,00 $65.0
Vision Titmus $26.00 $26.00
Offsite Administrative Fee $5.00 $5.00
Mc Gee William D. Audiometry W /Discrimination $65.00 $65.00
Vision Titmus $26.00 $26.00
Offsite Administrative Fee $5.00 5.00
Meyer, Amanda M. Audiomet WlDiscrimination $65,00 $65.0 0
Vision Titmus 26.00 $26.0 0
Offsite Administrative Fee $5.00 $5.OD
Polovick Tara L. Audiometry W /Discrimination $65.00 $65.0 0
Vision Titmus $26.00 $26.0 0
Offsite Administrative Fee $5.00 $5.00
Reed Michele R. Audiometry W /Discrimination $65.00 $65.0 4
Vision Titmus $26.00 $26.00
Offsite Administrative Fee $5.00 $5.00
Walton Marcia K. Audiometry WlDiscrimination $65,00 $65.00
Vision Titmus $26.00 $26.00
Offsite Administrative Fee $5,00 $5.00
Wenger Garry Audiomet W /Discrimination $65.00 65.00
Vision Titmus $26.00 26.00
Offsite Administrative Fee $5.00 5.00
Total Charges $1,976.00
Total Payments Balance Due $0.00 $1,976.00
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
$1,976.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1115 00 -11924 43- 509.00 $1,976.00 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
Wednesday, November 04, 2009
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by Stale 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))
10/28/09 I 00 -11924 I I $1,976.00
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
Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
i0 Carmel Clay Communications 1 CARMCOM
31 First Avenue NW Terms
Carmel, IN 46032 Invoice Date 11104/2009
M Invoice 00 -11968
Date Employee Description Amount Balance Due
10/27/09 Moore Lavernezetta H. Vision Titmus $26.00 $26.00
Audiometry WlDiscrimination $65.00 $65.00
10 /28/09 Collins Ashley M. Audiomet W1Discrimination $65.00 $65.00 y
Collins Mindy L. Audiometry WlDiscrimination $65.DO $65,00
Offsite Administrative Pee $5.00 $5.00
Vision Titmus $26.00 $26.0 0
Gordon Peggy D. Audiometry WlDiscrimination $65.00 $65.0 0
Paulin Kent E. Audiomet WlDiscrimination $65,00 $65.0 0
Phillips, Kerry N. Audiometry WlDiscrimination $65.00 $65.0 0
Reddick Joshua P. Audiomet W /Discrimination $65.00 $65.00
Stilts Denni Audiometry W Di rimination $65.00 $65.0
Tyler. Janice Y. Audiomet W /Discrimination $65.00 $65.00
Wolfe Lin L. Audiameta W /Discrimination $65.00 $65.00
Total Charges $707.00
Total Payments Balance Due $0.00 $707.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 E. New York Street, Ste 300
Indianapolis, In 46204
$707.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1115 00 -11968 43- 509.00 $707.00 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
Friday, November 06, 2009
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))
11/04/09 00 -11968 I $707.00
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
f 1
INVOICE
0 Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
C Carmel Fire Department I CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 10I28l2009
m Invoice 00 -11925
`Date Employee Description Amount Balance Due
10/19/09 Haboush David G. Health Ed Presentation Nutrition $175.00 $175.00
Health Ed Presentation Nutrition 175.00 $175,0 0
10/21109 Haboush David G. Health Ed Presentation In' Prev 175.00 $175.0 0
Health Ed Presentation In' Prev 175.00 $175.00
10/221091 Haboush David G. Health Ed Presentation In' Prev 175.00 175.00
Health Ed Presentation In' Prev 175.00 $175,00
10/23109 Haboush David G. Health Ed Presentation In' Prev 175.00 $175.0 0
Health Ed Presentation On Prev 175.00 $175.0 0
Total Char es $1,400.00
Total Payments Balance Due $0.00 $1,400.OQ
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797
date
VOUCHER NO. WARRA N
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$1,400.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #frITLE AMOUNT Board Members
1120 11925 43- 407.01 $1,400.00 1 hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
NOV 9 2009
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by Stale 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))
11925 $1,400.00
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