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Home My WebLink About170072 03/18/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 q ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $6,650.00 �?a CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 170072 CHECK DATE: 3/18/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 10680 245.00 MEDICAL EXAM FEES 1110 4340701 10681 1,851.00 MEDICAL EXAM FEES 1110 4340701 10725 4,554.00 MEDICAL EXAM FEES l INVOICE 0 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 03/03/2009 m Invoice 00 -10681 Date Employee Description Amount Balance Due 02/27/09 Collins. Willie H. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $16.00 $16.00 Respirator/Medical Review $16.00 $16.00 Treadmill (PFE) $153.00 $153.00 Waist/Hi Ratio $3.00 $3.00 Flexibility Check $10.00 $10.00 CMP $16.00 $16.00 CBC W /Dill And Plat $13.00 $13.0 0 Li id Panel $16.00 $16.001 Veniouncture Fee $3.00 $3.00 HIV 1 2 $13.00 $13.00 Quantiferon Tb Gold $50.00 $50.00 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 $3.00 Tonometry $36.00 36.00 Henry. David R. No -Show Fee $0.00 $0.001 Miller Michael G. Comprehensive Physical $91.00 91.00 OnMed Program $0.00 Health Risk Appraisal (Motivation) $16.00 $16.00 Res irator /Medical Review $16.00 $16.00 Treadmill (PFE) $153.00 15100 BIA (Bio -Elec Im ed Anal y) $14.00 $14.00 Waist/Hi Ratio $3.00 $3.00 Flexibility Check $10.00 $10.0 0 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 CG W/ Interp $20.00 $20.0 U rinalysis Di stick $3.00 $3.00 Tonometry $36.00 $36.00 Moore. Scott L. No -Show Fee $0.00 $0.00 Robbins. Todd Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation $16.00 $16.00 Respirator/Medical Review $16.00 $16.00 Treadmill (PFE) $153.00 $1.53.001 BIA Bio -Elec Im ed Anal 14.00 $14.00 Waist/Hip Ratio 3.00 $3.00 Flexibility Check $10.00 $10.0 0 Vital Signs HT WT BP P R $7.00 $7.00 t INVOICE H Public Safety Medical Services 324 E. New York Street: E Suite 300 Indianapolis, IN 46204 G Carmel Police Department/ CARMEPD I" 3 Civic Square Terms Carmel, IN 46032 Invoice Date 03!03!2009 m Invoice 00 -10681 Date Employee Description Amount Balance Due Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry 14.00 $14,0 0 ECG Wllnte 20.0 $20.0 0 Urinalvsis Dipstick $3.00 $3.00 Tonometry $36.00 $36.00 Wiegman. Chad R. Comprehensive Physical $91.00 $91.00 OnMed Proarem $0.00 $0.00 Health Risk Appraisal Motivation $16.00 $16.0 0 Respirator/Medical Review $1600 $16.0 0 Treadmill (PFE) $153.00 $153.00 Waist/Hi Ratio $3.00 $3,001 Flexibility Check 10.00 $10.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT WiIntero $33.00 $33.00 Audiometry $14.00 $1400 ECG W/ Interp $20.00 $20.00 Urinalvsis Dipstick $3.00 $3.Q0 Tonometry $36.00 $36.00 Williams. Ashiev L. I No -Show Fee $0.00 0.00 Total Charges $1,851.00 Total Payments Balance Due $0.00 $1,851.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date Y INVOICE Io Public Safety Medical Services 324 E. New York Street E Suite 300 Indianapolis, IN 46204 Carmel Police Department! CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 03/11/2009 a) Invoice 00 -10725 Date Employee Description Amount Balance Due 03/02/09 Henry David R. CMP $16.00 $16.00 CBC W /Dill And Plat $13.00 $13.D 0 Lipid Panel $16.DO 116.0 0 Veni uncture Fee $3,00 $3,00 HIV 1 2 $13.00 $13.DO Quantiferon Tb Gold $50.00 $50.00 HB SAb Quantitative Titer $35.00 $35.00 Moore Scott L. HIV 1 2 $13.00 $13.0 0 PSA $35.00 $35.00 HB SAb Quantitative Titer $35.00 $35.00 CMP $16,00 $16.0 0 CBC W /DiffAnd Plat $13.00 $13.00 Li id Panel $16.00 $16.00 Veni uncture Fee $3.00 $3.00 Quantiferon Tb Gold $50.00 50.00 Scott Curtis D. 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 $3.00. HIV 1 &2 $13.00 13.00 PSA $35.QQ $35.00 Q uantiferon Tb Gold $50.00 $50.0 0 HB SA Quslntitative Titer $35.00 $35, Williams, Ashley L. CMP $16.00 $16.00 CBC W /DiffAnd Plat $13.00 $13,0 0 Lipid Panel $16,00 S16.00 Veni uncture Fee $3.00 $3,00 Quantiferon Tb Gold $50.00 $50.0 0 03/06/09 Bodenhorn Wendy M. Comprehensive Physical $91.00 $91.0 0 OnMed Program $Q.DQ $0.00 Res iratorNedical Review $16.00 $16,00 Health Risk Appraisal Motivation 16.00 $16.0 0 Treadmill (PFE) $153.00 $153.00 Muscle Strength En urn -00 $26.0 0 Flexibility heck $1000 0 BIA Bio -Elec Irn ed Anal $14.00 $14.00 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 Audiometry 14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Tonometry $36.00 $36.0 0 Driver Charles E. Com rehensive Physical $91.00 91.00 OnMed Program 0.D0 0.00 INVOICE o Public Safety Medical Services 324 E. New York Street w E Suite 300 X Indianapolis, IN 46204 Carmel Police Department 1 CARMEPD Terms 3 Civic Square Invoice Date 03/11/2009 m Carmel, IN 46032 Invoice 00 -10725 Date 'Employee Description Amount Balance`Due Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Motivation 16.00 $16.00 Treadmill (PFE) $153.00 $153.00 Flexibility Check $10,00 $10.0 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 $33.0 0 Audiometry 14.00 $14.0 0 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00, Tonometry $36.00 $36.00 Henry, David R. Comprehensive Physical $91.00 $91,0 0 OnMed Program $0.00 $0.00 Respirator/Medical Review S16.00 16.00 Health Risk Appraisal Motivation 16.00 $16.00 Treadmill (PFE) $153.00 $153.00 Flexibility Check $10.00 $10.00 BIA Bio -Elec Im ed Anal $14.00 14.00 Waist/Hi Ratio $3.00 $3.00 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.0 0 Audiornetry $14,00 $14.0 0 ECG WI Interp $20.00 $20.00 Urinal sis Dipstick $3.00 $3,00 Tonometry $36.00 36.00 Hobson Phillip L. Camamhen ive Physical $91. $91.0 0 OnMed Program $0.00 $0.00 Res iratodMedical Review $16.00 $16.00 Health Risk Appraisal Motivation 16.00 $16.00 Treadmill (PFE) $153.00 $153.00 Flexibility Check $10.00 $10.0 0 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Waist/Hip Ratio $3.00 $3,00 Vital Si ns HT WT BP P R $7.00 $7.0 0 Vision Titmus $26.00 $26,00 PFT W/Interp $33.00 $33.0 0 Audiometry 14.0 $14.Q D CG VVI Interu 20.00 $20.0 Urinalysis Dipstick $3.00 $3.00 Tonometry $36.00 $36.00 Laker Jeffrey W. Com rehensive Physical $91.00 $91.0 0 OnMed Pro ram $0.00 $0.00 Respirator/ edical Review $16.00 $16.00 Health Risk Appraisal Motivation 16.00 $16.0 0 Treadmill (PFE) $153.00 153.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 0 Carmel Police Department! CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 03/11/2009 m Invoice 00 -10725 Date Employee Description Amount Balance Due Flexibilitv Check $10.00 $10.00 BIA Bio -Elec Im ed Anal 14.00 $14.0 0 Waist/Hi Ratio $3.00 $3.00 Vital Signs HT WT BP P R $7.00 7.00 Vision Titmus $26.00 $26.001 PFT W/Interp $33.00 $33.00 Audiometry 14.00 $14.0 0 ECG W/ Inter 20.00 $20.0 0 Urinalysis Dipstick $3.00 $3.00 Tonornetry $36.00 $36.00 Moore. Scott L. ggrngrehensive Physical $91.00 $91.0 OnMed Program $0.00 $0.00 Respirator/Medical Review $16.00 $16.00 Health Risk Appraisal Motivation 16.00 $16.00 Treadmill (PFE) $153.00 15100 Flexibility Check 10.00 $10.00 WaistYHi Ratio $3.00 $3.00 Vita! Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.D 0 PFT W/Interp $33.00 $33,00 Audiometry 14.00 $14.00 ECG W/ Interp $20.00 $20.0 0 Urinalysis Dipstick $3,00 $3.00 Tonometry $36.00 $36.00 Strong, David C. Com rehensive Physical $91.00 $91.00 OnMed Program $0.00 $0,00 Respirator/Medical Review $16.DO $16.0 0 Health Risk Appraisal Motivation 16.QQ $16.0 0 Treadmill (PFE) $153.00 $153.DO Flexibility Check $10.OD $10.0 0 Waist/Hi Ratio $3,00 $3.00 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W Ini r l) $33-00 $33,0 0 Audiometry $14.00 S14. ECG W1 Interp $20.00 $20.00 Urinal sis Dipstick $3.00 $3.00 Tonometry $36.00 $36.00 Tilson Travis C. Comprehensive Physical $91,00 $91.00 OnMed Program $0.00 $0.00 Respirator/Medical Review $16,00 $16.00 Health Risk Appraisal Motivation 16.00 $16.0 0 Treadmill (PFE $153.00 $153.00 Flexibility Check 10.00 110.0 0 Waist/Hi Ratio $3.00 $3.00 Vital Signs HT WT BP P R $7.00 1 7.00 INVOICE 0 Public Safety Medical Services =1 324 E. New York Street E Suite 300 a: Indianapolis, IN 46204 C Carmel Police Department/ CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 0311112009 m, Invoice 00 -10725 Date Employee Description Amount 1 13 alance Due Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry 14.00 $14.0 0 EGG W1 Infer Urinalysis Dipstick $3.00 $3.00 Tononnetry $36.00 $36.00 Williams Ashley L. 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 Flexibility Check $10.00 10.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Waist/Hi Ratio $3.OD $3.00 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 Audiornetry $14.00 $14.00 ECG W/ Interp $20.00 $20.00 Urinal sis Dipstick $3.00 $3.00 Tonometry $36.00 $36.00 Total Charges $4,554.00 Total Payments Balance Due $4:q0`; $4,554.00 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)) 3/3/ 10681 payment for officer physicals 1,851.00 3/ 11/09 10725 payMent for officer physicals 4,554.00 Total 6,405.-.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 VOUCHER NO. WARRANT NO. ALLOWED 20 P dblic Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 6,405.00 ON ACCOUNT OF APPROPRIATION FOR p olice general fund Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 10681 407 -01 1 851.00 bill(s) is (are) true and correct and that the 1110 10725 407 -01 4,554.00 materials or services itemized thereon for which charge is made were ordered and received except March 12 20 09 1 O ignature Assistant Chief of Polic Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE o Public Safety Medical Services w 324 E. New York Street E Suite 300 1W Indianapolis, IN 46204 C Carmel Fire Department I CARMEFD E 2 Civic Square Terms Invoice Date 0310312009 Carmel, IN 46032 Invoice 00.10680 Date T Employee Description I Amount Balance Due 02/24/09 Kilburn. Roger L. Fitness For Duty Level II $175.00 $175.00 Drua Screen 8) GClMS W /MRO $70.00 $70.00 Total Charges $245.00 Total Payments E. Balance Dus $0.00 $245.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date VOUCHER NO. WARRANT NO. ALLOWED 20 Public'Safety Medical Services IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $245.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members 1120 10680 43- 407.01 $245.00 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 VAR 1 6 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)) 10680 Fitness for Duty $245.00 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