168159 01/21/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
4 0 CHECK AMOUNT: $8,080.00
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 168159
CHECK DATE: 1/21/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340701 10396 462.00 MEDICAL EXAM FEES
1110 4340701 10397 7,618.00 MEDICAL EXAM FEES
INVOICE
t o Public Safety Medical Services
324 E. New York Street
E Suite 300
X Indianapolis, IN 46204
Carmel Fire Department CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 01/06/2009
Invoice 00 -10396
Date Employee Description Amount Balance Due
12/161D8 Medlen Michael J. Phy sical Level 3 $232.00 $232.00
OnMed Program 10.00 10.00
Treadmill (PFE) $165.00 $165.00
Funct Move Screen Pk 55.00 $55,00
Total Charges $462.00
Total Payments-& Balance Due moo-1 "'$462,00'
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 N
ALLOWED 20
Public Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$462.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT
Board Members
1120 10396 43- 407.01 $462.00 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
IAN 16 2009
o--
,g
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 �n:ev. 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))
10396 Physical $462.00
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
INVOICE
t o Public Safety Medical Services
324 E. New York Street
E Suite 300
W. Indianapolis, IN 46204
O Carmel Police Department I CARMEPD
Terms
3 Civic Square
Carmel, IN 46032 Invoice Date 01!0612009
m Invoice 00 -10397
Date Employee Description Amount Balance Due
12/15/08 McNair, Harland J. Exec 1 Wellness $61.00 $61.00
HIV 1 2 $0.00 $0.00
Quantiferon Tb Gold $50.00 $50.0 0
12/18/08 Bowman,Garyk 10 Cities $234.00 $234.00
OnMed Program $10.00 10.00
Treadmill (PFE) $165.00 $165.00
BIA Bio -Elec Im ed Anal 14.00 $14,00
Flexibility Check $7.00 7.00
Muscle Strength Endurance $23.00 $23.00
Waist/Hi Ratio $0.00 0.00
Dewald. Greciory S. No-Show Fee $0.00 $0.0
Fogarty Michael D. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
BIA Bio -Elec Irn ed Anal 14.00 $14.00
Flexibility Check $7.00 $7.00
Muscle Strength Endurance $23.00 $23.0 0
Waist/Hi Ratio $0.00 $0.00
Haymaker. William E. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
BIA Bio -Elec Im ed Anal 14.00 $14.0 0
Figxibility Check $7.00 $7.00
Muscle Strength Endurance $23.00 $23.00
WaisUft Ratio $0.00 $0.00
Hedrick Brad A. 10 Cities $234.00 $234.00
OnMed Program $10,00 $10.0 0
Treadmill (PFE) $165.04 $165.00
BIA Bio -Elec Im ed Anal 14.00 $14.0 0
Flexibility Check 7.00 $7.00
Muscle Strength Endurance $23.00 23.00
Waist/Hi Ratio $0.00 $0.00
Keith Brett A. 10 Cities $234.00 $234.0 0
nM d Program $10.00 $10.
Treadmill (PFE) $165.00 $165.00
BIA Bio -Elec Im ed Anal $14.00 $14.00
Flexibility Check $7.00 $7.00
Muscle Strength Endurance $23.00 $23.00
Waist/Hi Ratio $0,00 $0.00
Lytle, Blake A. No -Show Fee $0.00 $0.00
Miller Adam C. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.0 0
Treadmill (PFE) $165.00 $165.00
BIA Bio -Elec Im ed Anal 14.40 $14.0 0
Flexibility Check $7.00 $7.00
Muscle Stren th Endurance $23.00 $23.00
r
INVOICE
H Public Safety Medical Services
324 E. New York Street
E Suite 300
FY Indianapolis, IN 46204
O Carmel Police Department/ CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 01/06/2009
CID Invoice 00 -10397
Date Employee Description Amount Balance Due
Waist/Hi Ratio $0.00 $0.00
Morrow Scott A 10 Cities $234.00 $234.00
OnMed Program $10.00 $110.0 0
Treadmill (PFE) $1fi .0 1
BIA Bio -Elec Im ed Anal $14.00 $14.00
Flexibility Check $7.00 $7.00
Muscle Strength Endurance $23.00 $23.00
Waist/Hi Ratio $0.00 $0.00
Rush. Michael T. 10 Cities $234.00 $234.00
OnMed Program $110.00 $10.0 0
Treadmill (PFE) $165.00 $165.00
BIA Bio -Elec Im ed Ana! 14.00 $14.00
Flexibility Check 7.00 $7.00
Muscle Strength Endurance $23.00 $23.0 0
Waist/Hi Ratio 0.00 0.00
Stein Amy J. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.00
Treadmill (PFE) $165.00 $165.00
BIA Bio -Elec Im ed Anal $14.00 $14.00
Flexibility Check $7.00 $7.00
Muscle Strength Endurance $23.00 $23.00
Waist/Hi Ratio $0.00 SO.00
Zellers NancV L. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.0 0
Treadmill (PFE) $165.00 1165.00
BIA Bio -Elec Im ed Anal 14.00 $114.0 0
Flexibility Check $7.00 $7.00
Mu c!e Strencith Endurance $23.0 $23.0 0
Waist/Hi Ratio $0.00 $0.00
12/19/08 Dewald Gre o ry S. Exec 1 Wellness Offsite $61.00 $61.00
Jellison Ryan D. 10 Cities $234.00 $234.00
OnMed Program $10,00 $10.0d
Treadmill (PFE) $165.00 $165.00
FlexibilitV Check $7.00 $7.00
Waist /Hi Ratio $0.00 $0.00
12/22/08 Barlow. James C. Exec 1 Wellness 61.00 $61.00
HIV 1 2 $0.00 $0.00
Quantiferon Tb Gold $50.00 $50.0 0
Bickel, Jose h E. 10 Cities $234.0D $234.0
O nMed Program $10. $10.0
Treadmill (PFE) $165.00 $165.00
Body Fat Check Bod Pod $23.00 $23.00
FlexibilitV Check $7.00 $7.00
Waist/Hi Ratio $0.00 $0.00
12/26/08 Zellers Timothy V. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.00
Treadmill (PFE 1 $165.00 $165,00
;r
INVOICE
o Public Safety Medical Services
324 E. New York Street
E Suite 300
o Indianapolis, IN 46204
C Carmel Police Department I CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 01!0612009
m Invoice 00 -10397
Date Employee Description Amount Balance Due
Flexibility Check $7.00 $7.00
Waist/Hi Ratio $0.00 0.00
12/29108 Barlow James C. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10,00
Treadmill (PFE) $165.00 $165.00
BIA Bio -Elec Im ed Anal 14.00 $14.O 0
Flexibility Check $7,00 $7.00
Waist/Hi Ratio $0. 00 $0.0 0
Graham Bruce A. 10 Cities $234.00 $234.0 0
OnMed Program S10,00 10.00
Howard, Lana M. No -Show Fee $0.00 $0.
Mabie Michael L. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.00
Treadmill (PFE $165.00 $165.00
BIA Bio -Elec Im ed Anal 14.00 $14,00
Flexibility Check $7.00 7.00
Waist/Hi Ratio $0.00 $0.00
McNair Harland J. 10 Cities $234.00 $234.00
OnMed Program $10.00 $10.00
Treadmill WIFE) 165.00 $165.00
BIA Bio -Elec Im ed Anal 14.00 $14.0 0
Flexibility Check 7.D0 $7.00
Waist/Hi Ratio 0.0 0.00
Total Charges $7,618.00
Total Payments Balance Due $0.00 $7;616.00
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35- 2079797 date
Presc'ribod 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, Sutie 300 Terms
Indianapolis, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/6/ 09 10397 payment for officer physicals 7,618.00
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
VgUCHER NO. WARRANT NO.
ALLOWED 2Q
Public Safety medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 462044
7,618.00
ON ACCOUNT OF APPROPRIATION FOR
police g fu
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 10397 407 -01 7,618.00 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
.January 15 20 09
Signature
Chiaf of P01irP
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund