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174472 07/08/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $6,925.00 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 174472 CHECK DATE: 7/812009 DEPARTMENT ACCOUNT P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340701 11275 4,127.00 MEDICAL EXAM FEES 1110 4340701 11310 2,798.00 MEDICAL EXAM FEES ;r INVOICE F Public Safety Medical Services 324 E. New York Street E Suite 300 tY Indianapolis, IN 46204 0 Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 06/24/2009 Invoice 00 -11275 Date ...'Employee Description Amount Balance Due 06/15/09 Paris Mark J. CMP $16.00 $16.00 CBC W /DiffAnd Plat $13.DO $13.0 0 Lipid Panel $16.00 $16.00 Veni uncture Fee 3.00 $3,00 HIV 1 &2 $13.00 13.00 Quantiferon Tb Gold $50.00 $50.0 0 PSA $35.00 35.00 Park Greg A. CMP 16.00 16.00 CBC W /Dill And Plat $13.00 $13,0 0 Li id Panel $16.00 $16.00 V Fe $3.00 $3.0 Quantiferon Tb Gold $50.00 $50.00 Pitman Michael A. CMP $16.00 $16.00 CBC W /Dill And Plat $13.00 $13,00 Livid Panel $16.00 $16.00 Veni uncture Fee $3.00 $3.00 Quantiferon Tb Gold $50,00 $50.0 0 HIV 1 2 $13.OD $13.0 0 Smith Troy D. CMP 16.00 $16.00 CBC W /Dill And Plat $13.00 $13. 00 Lind Panel $16.00 16.00 Veni uncture Fee $3.00 $3.00 IV 1 &2 $13,00 $13, Quantiferon Tb Gold $50.00 $50.00 06/16/09 Molter Matthew S. CMP $16.00 $16.0 0 CBC W /Dill And Plat $13.00 $13.00 Li id Panel $16.00 $16.00 Veni uncture Fee $3.00 $3.00 Quantiferon Tb Gold $50.00 $50.001 06/19109 Dunlao, Christo her T. Comprehensive Physical 191.00 91.00 OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 16.00 $16.0 0 Respirator/Medical Review $16.00 $16.0 0 Treadmill (PFE) $153,00 $15 Flexibility Check $10.00 Waist/Hi Ratio $3.00 $3. Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W /Inter 3100 $33.00 AudiometrV $14.00 14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3,00 $3.00 Tonometry $36.00 $36.0 0 Flaming, Anna G. I Com rehensive Physical $91.00 $91.0 0 OnMed Program $0.00 $0.00 Health Risk Apnraisal Motivation 16.00 16.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 X Indianapolis, IN 46204 C Carmel Police Department I CARMEPD J 3 Civic Square Terms Carmel, IN 46032 Invoice Date 06124/2009 Invoice 00 -11275 Date Employee Description Amount Balance Due Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Em ed Anal 14.00 $14.0 0 Waist/Hi Ratio $3.00 $3.0 0 Flexibilit C k $10.00 $10. Treadmill (PFE) $153.00 $153.00 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 $14.0 0 ECG W! Interp $20.00 $20.0 0 Urinalysis Dipstick $3.00 3.00 Tonometry $36.00 $36.00 Long, Scott D. CMP $16.00 16.00 CBC W /Dill And Plat $13.00 $13.00 Lipid Panel $16.Q0 $16.0 0 Veni uncture Fee $3.00 $3.00 Quantiferon Tb Gold $50.00 $50.00 HIV 1 2 $13.00 $13.00 Mallov, Katherine E. Comprehensive Physical $91.00 $91.0 0 OnMed Program $0,00 $0.00 Health Risk Appraisal Motivation 16.00 $16.00 Respirator/Medical Review $16.00 $16.0 0 Treadmill (PFE) $153.00 $153.00 Waist/Hi Ratio $3.00 $3,00 Flexibility Check $10.00 $10.00 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. 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 Molter Matthew S. Comprehensive Physical $91.00 $91.0 0 OnMed Program $0.00 $0.0 0 Health Risk Appraisal Motivation 16.00 $16.00 Respirator/Medical Review $16.00 $16.0 0 Treadmill (PFE) $153.00 $153.00 W i Hi Ratio 3.00 Flexibility Che k $10.00 $10'D Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $3100 Audiometry $14.00 $14.00 ECG W! Interp $20.00 $20.00 Urinalysis 3.00 $3.00 Tonometry $36.00 S36.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 tY Indianapolis, IN 46204 o' Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 06/24/2009 m Invoice 00 -11275 Date Employee Description Amount Balance:Due Paris Mark J. 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 Waist /Hi Ratio $3.00 $3.00 Flexibility Check 10.00 $10.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT W/Interip $33.00 $33.00 Audiornet $14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Tonornetry $36.00 $36,0 0 Schoeff Jr. Donald D. i 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 Flexibility Check $10.00 $10.00 Waist/Hi Ratio S100 100 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus 26. 26. 0 PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14.00 ECG W/ Interp $20.00 $20,00 Urinalysis Dipstick $3.00 $3,00 Tonometry $36.00 $36.0 0 Scott Curtis D. Comprehensive Physical $91.00 $91.00 OnMed Program $0.00 0.00 Health Risk Appraisal Motivation 16.00 $16.0 0 Respirator/Medical Review S16.00 $16.0 0 Treadmill (PFE) $153.00 $153.00 Waist/Hi Ratio $3.00 $3.00 Flexibility Check 10.0 $10.0 0 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT W/Interp $33.DO $33.00 Audiornetry $14.00 $14.0 0 ECG W/ Interp 20.00 $20.00 Urinalysis Dipstick 3.00 S3.00 Tonometry $36.00 $36.00 Smith Troy D. Comprehensive Physical $91.00 $91.0 0 OnMed Program 0.00 $0,00 Health Risk A raisal Motivation 16.00 $16.0 0 Respirator/Medical Review 16.00 16.00 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 o Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 06124!2009 m Invoice 00 -11275 Date Employee Description Amount Balance Due Treadmill (PFE $153.00 $153.00 Flexibility Check $10.00 $110.0c Waist/Hi Ratio $3.00 $3.D 0 Vital Si ns HT WT BIP P R $7 $7 Vision Titmus $26.00 $26.00 PFT W/Interp $33.00 $33.00 Audiometry $14.00 $14.00 ECG W/ Inter 20.00 20.00 Urinalysis Dipstick $3.00 $3.00 Tonometry $36.00 $36.00 Total Charges $4,127.00 Total Payments Balance Due $0.00 $4,127.00 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. NewZYork Street, Suite 300 Terms Indianapolis, IN 46204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 6/24/09 11275 'a' bnt for officer physicals 4,127.00 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 4,127.00 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 11275 407 -01 4,127. o bills) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except June 29 20 09 Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund e' INVOICE o Public Safety Medical Services r 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Police Department 1 CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 07!0112009 m Invoice 00 -11310 Date Employee Description Amount Balance Due 06124/09 Foster Johnathan A. 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 Waist/Hi Ratio $3.00 $3.00 Flexibilit y Check $10.00 $1Q.0 0 Treadmill (PFE) $153.00 153.00 Vital Si ns HT WT BP P R $7.00 7.00 Vision Titmus $26.00 $26.0 0 PFT W /Inter 33.00 $33.00 Audiometry $14. 14.0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Tonometry $36.00 $36.0 0 Long, Scott D. 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 Waist/Hi Ratio $3.00 $3.00 Flexibilitv Check $10.00 $10,00 Treadmill (PFE) $153.00 $153.00 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 Park Greg A. Comprehensive Physical $91.00 $91.0 0 OnMed Program 0.00 0.00 Health Risk Appraisal Motivation 16.00 S16.00 Respirator/Medical Review 16.00 $16.0 0 BIA Bio Elec Im ed Anal 14.00 $14.0 0 Waist/Hi Ratio $3.00 $3.00 Flexibility Check 1 1 T readmill (PFE) $1 15 .00 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 Audiometry $14.00 14.00 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3.00 Pitman Michael A. Comprehensive Physical $91.00 $91,00 OnMed Program $0.00 $D.OD Health Risk Appraisal Motivation 16.00 $16.0 0 Respirator/Medical Review 16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Waist/Hi Ratio $3.00 $3.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 IY Indianapolis, IN 46204 o Carmel Police Department/ CARMEPD 3 Civic Square Terms t Carmel, IN 46032 Invoice Date 07/01/2009 m Invoice 00 -11310 Date Employee Description Amount Balance Due Flexibility Check 110.00 $10.00 Treadmill (PFE) $153.00 $153.001 Vital Si ns HT WT BP P R $7.00 $7.00 Visio Titmus 2 6 PFT W/Interp $33.00 $33.00 Audiornetry $14.00 $14.00 ECG W1 Interp $20.00 $20.00 Urinalysis Dipstick 3.00 $3.00 Tonometry $36.00 $36.00 Semester James S. Comprehensive Physical $g1.00 $91.0 0 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 16.00 $16.0 0 Res irator /Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 $14.00 Waist/Hi Ratio $3.00 $3.OG Flexibilit Check 10.00 $10.0 0 Treadmill (PFE) $153.00 $153.00 Vital Signs HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.00 PFT WAnterp $33.00 $33.0 0 Audiometry 14.00 $14.0 0 ECG W/ Interp $20.00 $20.00 Urinalysis Dipstick $3.00 $3,00 Tonometry $36,DO $36.0 0 Stein Am J. Comprehensive Physical $91.00 $91.0 0 OnMed Pro ram $G,0G $0.00 Health Risk Appraisal Motivation 16.00 $16.0 0 Respirator/Medical Review $16. $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 Muscle Strength Endurance $26,00 $26.00 Treadmill (PFE) $153.00 $153.00 Vital Si ns HT WT BP P R $7.00 $7.00 Vision Titmus $26.00 $26.0 0 PFT Winter 33.00 $33.DO Audiornetry $14.00 $14.0 D ECG W/ Inter 20.00 $20.001 Urinalysi D nstick $3.00 $3.00 Tonometry $36.00 $36. Towle John R. Comprehensive Physical $91.00 $91.00 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation $16.00 $16.00 Respirator/Medical Review $16.00 $16.00 BIA Bio -Elec Im ed Anal 14.00 14.00 Waist/Hi Ratio $3.OD 3.00 Flexibility Check 10.00 10.00 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 M. Indianapolis, IN 46204 G Carmel Police Department I CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 07!01!2009 m Invoice 00 -11310 Date Employee Description Amount Balance Due 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 $14.0 0 ECG Wl Interp $20.00 $20.00 Urinalysis Di stick 3.00 $3.0d Total Charges $2,798:00 Total Payments &Balance Due y I$0,00 $2;798x00 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) f 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 Pu blic Safety Medical Services Purchase Order No. 324 E. New York Street, Suite 300 Terms Indianapolis, IN 467204 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 7/1/09 11310 payment for officer physiclas 2,798.00 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 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 2,798.00 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 11310 407 -01 2,798. o 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 July 2 2 0 09 Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund