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Home My WebLink About177368 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 0 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $8,799.00 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 177368 CHECK DATE: 9/1512009 DEPARTMENT ACC OUNT PO NUMBER IN VOICE NU MBER AMOUNT DESCRIPTION 1120 4340701 11609 3,361.00 MEDICAL EXAM FEES 1110 4340701 11610 5,438.00 MEDICAL EXAM FEES INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 C Carmel Fire Department 1 CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 0910112009 Gct Invoice 00 -11609 Date Employee Description Amount Balance Due 08/24/09 Benbow, Kip S. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 16.00 $16.0 0 Respirator/Medical Review $16.00 $16.0 0 Treadmill (PFE) $153.00 $153.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Waist/Hi Ratio $3.00 $3.0 0 Flexibility Check $10.00 $10.0 0 Nutri Assessment Questionnaire $16.00 $16.0 0 Bladder Cancer Screen $45.00 $45.00 Vital Sin HT WT BP P $7.00 $7. Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry 14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinal sis Dipstick $3.00 $3.00 Hoover. Anthonv B. Comprehensive Physical 91.00 $91.00 OnMed Program $0,00 $0,00 Respirator/Medical Review $16.00 $16,00 Health Risk AvUraisal Motivation 16.00 16.00 Bladder Cancer Screen 45.00 $45.0 0 Nutri Assessment guestionnaire $16.00 $16.0 0 Treadmill (PFE) $1 153.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT Wllnter 33.00 $33.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 08/27/09 Castor Rick S. Comprehensive Physical $91.00 $91.00 Health Risk Apipraisal Motivation 16.00 $16.0 0 O nMed Pro ram $0.00 $0.00 Respirator/Medical Revi w $16.00 $16.0 BIA Bio -Elec Im ed Anal $14.00 $14.00 Waist/Hi Ratio $3.00 $3.00 Flexibilitv Check $10.00 $10.00 Treadmill (PFE $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.0 0 Vital Signs HT WT BP P R $7,00 $7.00 Vision Titmus $26,00 $26.0 0 PFT Wllnter 33.00 33.00 Audiometry $14.00 $14.00 ECG W/ Intery $20.00 $20.0 0 INVOICE �o Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 0 Carmel Fire Department/ CARMEFD Terms I 2 Civic Square Carmel, IN 46032 Invoice Date 09101/2009 C0 Invoice 00 -11609 Date Employee Description Amount Balance Due Urinalysis Dipstick $3,00 $3.00 Ellison Christo her M. Comprehensive Physical $91.00 sgim Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Pro r m $0,00 Res iratorlMedical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal $14.00 $14.00 Flexibility Check $10.06 $10.00 Waist/Hi Ratio $3.00 $3.0o Treadmill (PFE) $153.00 $153.00 Exercise Prescription- $35.00 $35,00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.0 0 Audiometry 14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Kehl William D. Comprehensive Physical $91.00 $91.00 Heath Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 0.00 Res irator /Medical Review $16.DO $16.0 0 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 $153.00 Exercise Prescription $35.00 $35.00 N tri As essment Questionnaire $16.00 $1 6.0 Bladder Cancer Screen $45.00 $45.00 Hemoccult $5.00 $5.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry 14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.0D Small Thomas D. Com rehensive Ph sical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Pr r m $000 $O.OD Res6ratortMedical Review $16.00 $1 6-00 BIA (Bic-Elec Im ed Anal $14.00 $14.00 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Muscle Strength Endurance $26.00 $26.00 Treadmill (PFE $153.00 153.00 Nutri Assessment Questionnaire $16.00 $16.00 Bladder Cancer Screen S45.00 $45.nn INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 G Carmel Fire Department I CARMEFD 2 Civic Square Terms Carmel, IN 46032 Invoice Date 09/01/2009 m Invoice 00 -11609 Date Employee Description Amount Balance Due Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W/Interp $33.00 $33.D 0 Audiometry 14.00 $14.00 ECG WI Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Steele Jeffrev A. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 16.00 16.00 OnMed Program $0.00 $0,00 Res irator /Medical Review $16.00 $16.00 BIA (Bio-Elec Imped An I 14.00 $14.0 0 Flexibility Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill PFE $153.00 $153.00 Nutri Assessment Questionnaire $16.00 $16,00 Bladder Cancer Screen $45.00 $45.00 Vital Signs HT WT BP P R $7.00 $7.OD Vision Titmus $26.00 $26.0 0 PFT W/Interp $33.00 $33.0 0 Audiometry 14.00 14.00 ECG WI Interp $20.00 $20.00 Urinalysis Di stick $3.00 $3.00 Hemoccult 5. 0 0 Total Charges $3,361.00 Total Payments Balance Due $OAO $3,361.00' Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date VO NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $3,361.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #[TITLE AMOUNT Board Members 1120 11609 43- 407.01 $3,361.00 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 SEP 14 2009 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)) 11609 $3,361.00 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 Fo- 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 09/01/2009 m Invoice 00 -11610 Date Employee Description Amount Balance Due 08120/09 Dewald Gregory S. CMP Done At MACL Lab $16.00 $16.00 CBC W /Dill And Plat $13.00 $13.0 0 Lipid Panel $16.00 $16.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 PSA $35.00 $35.0 0 08/25/09 Lytle. Blake A. CMP $16.00 $16.0 0 CBC W /Dill And Plat $13.00 $13.00 Lipid Panel $16.00 $16.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13,00 $13.0 Quantiferon Tb Gold $50.00 $50.00 HB SAb Quantitative Titer $35.00 $35.00 08/26/09 Buttice Jennifer R. CMP $16.00 $16.0 0 CBC W /Dill And Plat $13.00 $13.00 Lipid Panel $16.00 $16.0 0 Veni uncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.0 0 Quantiferon Tb Gold $50.00 $50.00 FIB SAb Quantitative Titer $35.00 $35.00 08/27/09 Bowman Gary A. Comprehensive Physical $91.00 $91.00 Health Risk A raisal Motivation 16.00 $16.00 O M dP $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 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 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interlp $33.00 $33.00 Audiometry 14.00 $14.00 ECG W/ Inter 20.00 $20.0 0 Urinalysis Di stick $3.00 $3.00 0 8/28/09 Amo Chad No -Show Fee $0.00 0.00 Buttice Jennifer R. Com rehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Tonometry $36.00 $36.001 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.0 0 Audiometry 14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 3.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 as w Indianapolis, IN 46204 G Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 09/01/2009 Invoice 00 -11610 Date Employee Description Amount Balance Due Dewald Greaory S. Comprehensive Physical $91.00 $91.00 Health Risk A raisal Motivation 16.00 $16.00 OnMed Program $0.00 Soo 0 R s irator Medical Review $16,00 $16. Flexibility Check $10.00 $10.00 WaisUft Ratio $3.00 $3.00 Quantiferon Tb Gold $50.00 $50.00 TcnometrV $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 AudiometU $14.00 14.00 ECG W/ Interp 120.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Frost Dwi ht D. Comprehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motivation 15.00 $16.0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Flexibilit Check $10.00 $10.00 WaisUft Ratio $3.00 3.00 Treadmill (PFE) $153.00 $153.00 Hemoccuit $5.00 $5,00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $25.00 $26.0 0 PFT W/Interp $33.00 $33.0 0 Audiometry 14.00 $14.00 ECG W/ Interp $20.00 $20.0 0 Urinalysis Di ti k $3,DO Gerdt, Andrew P. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Flexibility Check $10.00 10.00 Waist/Hi Ratio $3.00 $3,00 Treadmill (PFE) $153.00 $153,00 Tonomet 36.00 $36.00 Vital Si ns HT WT BP P R 7.00 $7,00 Vision Titmus $26.00 $26.0 0 PFT W/InteCp $33.00 $33.00 Audiometry 14.0 $14.00 ECG W1 Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Harris Robert P. Comprehensive Physical $91.00 $91.0 0 Respirator/Medical Review $16.00 $16,00 Health Risk Appraisal Motivation 16.00 116.00 OnMed Program 0.00 0.00 Flexibility Check $10.00 $10. 00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 tY Indianapolis, IN 46204 G Carmel Police Department CARMEPD F 3 Civic Square Terms Carmel, IN 46032 Invoice Date 09/0112009 Invoice 00 -91610 Date Employee Description Amount Balance Due Waist/Hip Due- Waist/Hip Ratio $3.00 $3.00 Treadmill PFE 153.00 $153.00 Quantiferon Tb Gold $50.00 $50.00 Tonometry $36.00 36.00 Vital Si ns HT WT BP P R 7.00 $7.00 Vision Titmus $26,00 26.00 PFT W /Inter 33.00 $33.00 Audiometry 14.00 $14,0 0 ECG Wl Interp $20.00 $20.0 0 Urinal sis Dipstick $3.00 $3.00 Harris. Sarah E. Comprehensive Physical $91,00 $91.Q 0 Health Risk Appraisal Motivation $16.00 $16.00 OnMed Program 0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Flexibilitv Check $10.00 $10.00 Waist /Hi Ratio $3.00 $3,00 Treadmill (PFE $153.00 $153.00 TonornetrV $36,00 $36.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus S26.00 $26.00 PFT W/Interp $33,00 $33.00 Audiometry 14.00 $14.0 0 ECG W/ Intero $20.00 20.0 Urinalysis Dipstick $3.00 $100 Haymaker William E. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Program 0.00 $0.00 Respirator/Medical Review $16.00 $16.0 0 Flexibility Check $10.00 $10.0 0 Waist/Hi Ratio $3,00 $3.00 Treadmill (PFE) $153.00 $153.00 Quantiferon Tb Gold $50.00 50.00 Tonomet 36.00 $36.0 0 Vital Signs HT WT BP P R $7.00 $7. Vision Titmus $26.00 $26.001 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 Lytle, Blake A. Comprehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 $16.Q0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Flexibilitv Check $10.00 $10.00 Waist/Hi Ratio $3.00 3.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street Suite 300 Indianapolis, IN 46204 G Carmel Police Department I CARMEPD f 3 Civic Square Terms Carmel, IN 46032 Invoice Date 09/01/2009 Invoice 00.11610 Date Employee Description Amount Balance Due Treadmill (PFE) $153.00 $153.00 Tonometry $36.00 $36.00 Vital Signs HT WT SP P R $7.00 $7.00 Vi ion Titmus $2Q.QQ S26.0 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 Pelzer, Robert S. Comprehensive Physical $91,00 $91.0 0 Health Risk Appraisal Motivation 16.00 $16.0 0 OnMed Pro ram $0.00 $0.00 Respirator/Medical Review $16,00 $16.001 Flexibility Check $10.00 $10.D 0 Waist/Hi Ratio $3,00 $3.00 Treadmill (PFE) $153.00 $153.0 0 Tonomet 36.00 $36.0 0 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry $14.00 $14.00 ECG W/ Interp $20,00 $20.00 Urinal sis Dipstick $3,00 $3.00 Vanderbeck David R. Com rehensive Physical $91.00 $91.00 Health Risk Appraisal Motivation 16.00 S16,0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Flexibility Check $10.00 $10.00 W i Hi Ratio $3.00 $3.001 Treadmill (PFE $153.00 $153.00 Quantiferon Tb Gold $50.00 $50.00 Tonometry $36.00 $36.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W /Inter 33.00 $33.00 Audiometry 14.00 $14.001 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 White Kari E. Com rehensive Physical $91.00 $91.0 0 Health Risk Appraisal Motiv tin $16.00 $16.0 -O nMed Pro ram $0.00 0.00 Respirator/Medical Review $16.00 $16.00 Flexibilitv Check $10.00 $10.00 Waist/Hi Ratio $3.00 $3.00 Treadmill (PFE) $153.00 $153.00 Quantiferon Tb Gold $50.00 $50.00 Tonometry $36.00 $36,00 Vital Si ns HT WT BP P R $7.00 7.00 INVOICE a Public Safety Medical Services 324 E. New York Street E Suite 300 m Q� Indianapolis, IN 46204 o Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 09/01/2009 Invoice 00.11610 Date Employee Description Amount Balance Due Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiomet 14.00 $14.0 0 ECG W1 Interp $20.00 $20.00 Urinalysis Dipstick $3.00 3.00 Total Charges $5,438.00 Total Payments &Balance Due $0.00 $5,438.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from invoice date PresCrihed by State Hoard 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)) 9/1/09 11610 payment for officer physicalsq 5,438.00 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 Indianapolis, IN 46204 5.438.00 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 11610 407 =011 5,438.00 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 September 4 20 Og Signature Chief of POlice Cost distribution ledger classification if Title claim paid motor vehicle highway fund