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Home My WebLink About179815 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $6,400.00 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 179815 CHECK DATE: 11/24/2009 DEPARTMENT ACCOUNT PO NUMBER INV OICE NUMBER AMOUNT DESCRIPTION 11120 4340701 11969 120.00 MEDICAL EXAM FEES 1120 4340701 12006 2,265.00 MEDICAL EXAM FEES 1110 4340701 12007 4,015.00 MEDICAL EXAM FEES INVOICE 0 Public Safety Medical Services 324 E. New York Street Suite 300 W Indianapolis, IN 46204 Carmel Fire Department 1 CARMEFD Terms 2 Civic Square Invoice Date 11111120091 m Carmel, IN 46032 Invoice 00- 12006 Date Employee Description Amount Balance Due 11102/09 Baskerville. Anthony A. Low Back Ortho Eval Pk $80.00 $80.00 Bowles Orbie H. Low Back Ortho Eval Pk 80.00 180.0 0 Butts Joseph A. Low Back Ortho Eval Pk 80.00 $80,0 0 Edwards Daniel E. Low Back Ortho Eval Pk 80.00 $80.00 Fisher Gary L. Low Back Ortho Eval Pk 80.00 $BO.00 Haus Joshua S. Low Back Ortho Eval Pk 80.00 $80.0 0 McNair. Travis L. HB SAb Quantitative Titer $35.00 35.00 iviuwe Anthon W- HB SAb Quantitative Titer $35.00 $35.0 0 Robinson Mark G. Low Back Ortho Eval Pk 80.00 $80.0 0 Rohr Christopher M. Low Back Ortho Eval Pk 80.00 $80.00 Thordarson. Erik M. HB SAb Quantitative Titer $35.00 $35. W ant Andrew D. Low Back Ortho Eval Pk $80.00 $80.00 11/04/09 Bartrom, Brad A. Low Back Ortho Eval $80.00 $80.00 Hoover Anthony B. Low Back Ortho Eval $80.00 $80.00 Mulford David A. Low Back Ortho Eval $80.00 $80.00 Nicley, Wes W. Low Back Ortho Eval 80.00 $80,00 Ray. Lucas M. Low Back Ortho Eval $80.00 $80.0 0 Sombke Brad D. Low Back Ortho Eval $80.DO $80.00 Sutton Sean B. Low Back Ortho Eva; $80.00 SKOD Toney, James D. Low Back Ortho Eval $80.00 80.00 Whitaker Charles E. Low Back Ortho Eva! $80.00 $80.0 0 11/05/09 Conner Timothy L. Low Back Ortho Eval $80.00 $80,0 0 DeCrastos, Richard A. Low Back Ortho Eval $8Q.00 $80.0 0 Edwards, Steven L. Low Back Ortho Eval $80.00 $80.00 Hulett Mark A. Low Back Ortho Eval $80.00 $80.00 Kinnev, Jared N. Low Back Ortho Eval $80.00 80.00 Marsh Michael A. Low Back Ortho Eval $80.00 $80.0 0 McNab. John D. Low Back Ortho Eval $80.00 $80.00 Smith Brian E. Low Back Ortho Eva! $80.00 $80.0 0 Vallone. f=rank Low Back Ortho Eval 80.00 80.00 Totai Charges $2,265.00 Total Payments Balance Due y $0.00 .$2,265.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date INVOICE oo Public Safety Medical Services Ir- 324 E. New York Street E Suite 300 tY Indianapolis, IN 46204 Carmel Fire Department 1 CARMEFD Terms 2 Civic Square Carmel, IN 46032 Invoice Date 11/04/2009 m Invoice 00 -11969 Date Employee Description Amount Balance Due "0/27/09 Reeves Neil P. Chest PA/LAT $60.00 $60.00 Starr GregorV A. Chest PA/LAT $60.00 $60.00 Total Charges $120.00 Total Payments Balance Due $0.00 20.00. 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 East New York Street, Ste. 300 Indianapolis, IN 46204 $2,385.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 11969 43- 407.01 $120.00 1 hereby certify that the attached invoice(s), or 1120 12006 43 407.01 $2,265.00 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 r n 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)) 11969 $120.00 12006 $2,265,00 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 r INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Police Department! CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11 /1 1/2009 m Invoice 00 -12007 Date Employee Description Amount Balance Due 11/02/09 Amos Chad B. Comprehensive Physical $91,00 $91.00 Health Risk Appraisal Motivation 16.00 116.0 0 OnMed Program ().Do $0,00 Respirator/Medical Review 16.00 116,00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 3.00 Treadmill (PFE) $153.00 S153.D0 Tonornetry $36.00 $36.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT WlInterp $33.00 $33.00 Audiomet $14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinal sis Di stick $3.00 $3,00 Buttice. Jennifer R. No -Show Fee $0.00 $0.00 Clark Sr.. Todd C. Comprehensive Physical 91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program 0.00 $D.00 Respirator/Medical Review $16.00 $16.00 BIA (Bic)-Elec Im ed Anal 14.00 $14.0 0 Flexibility Check $10.00 10.00 Waist/Hi Ratio Muscle Strength Endurance $26.00 $26.00 Treadmill (PFE) $153,00 $153.00 Tonomet 36.00 $36.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus 26.00 $26.D 0 PFT W/Interp $33.00 $33.0 0 Audiomet S14.00 Q4.00 ECG W/ Interp $20.00 $20.D 0 Urinalysis Di stick $3.00 $3,00 Graham Bruce A. Comprehensive Physical $91.00 191.D 0 Health Rik raisal Motivation 16.0 $16. Q nMed Program $0.00 S0. Respirator/Medical Review $16.00 $16.00 Waist/Hi Ratio $3.00 $3.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 Tonometry $36.00 $36.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26,00 $26.00 PFT W/Interp $33.00 $33.00 AudiometrV $14.00 14.00 ECG W/ Interp $20.00 S20.00 Urinalysis Dipstick 3.00 $3.00 Horner Jeffrey J. Com rehensive Physical $91.00 $91.00 INVOICE I0 Public Safety Medical Services w 324 E. New York Street E Suite 300 Indianapolis, IN 46204 o Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11!1912009 m Invoice 00 -12007 Date Employee Description Amount Balance Due Health Risk Appraisal Motivation 16.00 $16.00 OnMed Pro ram $0.00 $0.00 Respirator/Medical Review $16,00 $16.0 0 BIA (Bio-Elec Imned Anal y) $14.00 $14. Flexibilitv Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Tonometry $36.00 $36.00 Vital Signs HT WT BP P R $7.00 $7,00 Vision Titmus $26.00 $26,0 0 PFT W/Interp $33.00 $33,0 0 Audiometry 14.00 $14.00 ECG W1 Inter 20.00 $20.0 0 Urinalysis Di stick $3.00 $3.00 Klein Marc A. Comprehensive Physical 91.00 $91,00 Health Risk Aopraisal Motivation 16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153,001 Tonometry $36.00 $36.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W/Interp $33.00 $33.0 0 Audiometry 14.00 $14.0 0 ECG W Interp $20.00 20. Urinalysis Dipstick $3.00 $3.00 Matthews Daniel M. Com rehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Motivation 16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Flexibility Check 10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Tonometry $36.00 $36.0 0 Vit I Si ns HT WT BP P R $7.00 $7.00 Vision Titmus 126.00 2 PFT W /inter $3100 $33.00 Audiornetry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinal sis Di stick $3.00 $3.00 Me er Ryan J. Comprehensive Physical 191,00 $91.00 Health Risk Appraisal Motivation 16.00 16.00 OnMed Program $0.00 0.40 INVOICE t o Public Safety Medical Services w 324 E. New York Street E Suite 300 Indianapolis, IN 46204 G Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11/11/2009 m Invoice 00 -12007 Date Employee Description Amount Balance Due Respirator/Medical Review $16.00 $16.00 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Tonometry $36.00 $36.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W/Interp $33.00 $33.00 Audiometry 14.00 $14.0 0 ECG W/ Inte 20.00 $20.00 Urinal 's Di stick $3.00 $3.0 11/05/09 Carey, Luckie A. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Health Risk Appraisal Motivation 16.00 $16.00 Treadmill (PFE) $153.00 $153.00 Body Fat Check Bod Pod $14.00 $14.0 0 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3.00 $3.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 A udiometry 14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinal sis Dipstick $3.00 $3.00 Tonometry $36.00 $36.0 0 Gauthier Edward B. 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 Drug Screen 8 GUMS W /MRO $70.00 $70.0 0 Applicant Health Screen PERF $101.00 $101.00 Vital Signs HT. WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 C olor Vision (Ishiharal $26.00 26.00 PFT W/Interp $33.00 $33.00 Audiometry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Tonometry $36.00 $36.00 Total Charges $4,015.00 Total Payments Balance Due $0.00 $4,015.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 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)) 11/11/09 12007 payment for officer physicals and h sica 4,015.00 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 East New York Street, Suite 300 Indianapolis, IN 46204 4.015.00 ON ACCOUNT OF APPROPRIATION FOR police generla ufnd Board Members Pots or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 12007 407 -01 4,015.00 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 18 20 09 Signature Chief of P01 ice Title Cost distribution ledger classification if claim paid motor vehicle highway fund