172997 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,581.00
ti`•, CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
INDIANAPOLIS IN 46204 CHECK NUMBER: 172997
CHECK DATE: 5/27/2009
DEPAR ACCOU PO NUMB INVOICE NUMBER AMO UNT DES CRIPTION
1110 4340701 11053 257.00 MEDICAL EXAM FEES
1120 4340702 11091 70.00 SHO'T'S INOCULATIONS
1110 4340701 11092 3,254.00 MEDICAL EXAM FEES
i
INVOICE
o Public Safety Medical Services
324 E. New York Street
Suite 300
a: Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPD
t" 3 Civic Square Terms
Carmel, IN 46032 Invoice Date 05!1312009
Invoice 00 -11053
Date Employee Description Amount Balance Due
05/04/09 VanNatter Shane R. CMP $16.00 $16.00
CBC W1Diff 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
HB SAb Quantitative Titer $35.00 $35.00
Quantiferon Tb Gold $50.00 $50.0 0
05/07/09 Hood Bryan L. CMP $16.00 $16.0 0
CBC WIDiff And Plat 113.00 $13.00
Lipid Panel $16,00 $16.00
Venir)uncture Fee $3,00 $3.0
HIV 1 2 $13.00 $13.00
Quantiferon Tb Gold $50.00 $50.nn
Total Charges $257.00
Total Payments Balance Due $0.00 $257.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
INVOICE
H Public Safety Medical Services
r 324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
0 Carmel Police Department 1 CARMEPD
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 05/20/2009
m Invoice 00 -11092
Date Employee Description Amount. Balance Due
05/11/09 Case Todd L 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.DQ $16.0 0
Treadmill (PFE $153.00 $153.OD
Flexibility Check $10.00 $1D.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 WfInterp $33.00 $33.00
A diom $14-00 $14.Q0
ECG W/ Interp $20.00 $20.00
Urinalysis Dipstick $3.00 3.00
Tonornetry $36.00 $36.00
Dietz Aaron K. 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 $3.00
Flexibility Check $10.00 $10.00
Vt l n -HT WT BP PR 7. 0 7.0
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
Hemoccult $5.00 $5.00
HB SAb Quantitative Titer $35.00 $35.0 0
PSA $35.00 $35.00
Harting, Charles V. Hemoccult $5.00 5.00
C omprehensive Physical $91.00 $91.00
On Med Pr r m $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
BIA Bio -Elec Im ed Anal 14.00 $14.0 0
Waist/Hi Ratio $3.00 3.00
FlexibilitV Check $10.00 $10.00
Muscle Strength Endurance $26.QQ $26.0 0
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 14.00
INVOICE
F Public Safety Medical Services
324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPQ
3 Civic Square Terms
Carmel, IN 46032 invoice Date 05!2012009
m invoice 00 -11092
Date Employee Description Amount Balance Due
ECG W/ Inter 20.00 $20.00
Urinalysis Di stick $3.00 $3.001
Tonometry $36.00 $36,00
HB SAb @uantitative Titer $35.00 $35.
Hood, Bryan L. 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
FlexibilitV Check $10,00 $10.001
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
AudiometFy $14.00 $14.00
ECG Wl Interp $20,00 $20.00
Urinal sis Dipstick $3.00 $3.00
Tonometry $36.00 $36.00
Jent. Danny N. Comprehensive Physical $91.00 $91.00
OnMed Program $0.00 $0.00
Health Risk A raisal Motivation 16.00 $16.00
Respirator/Medical Review $16.00 $16.00
Treadmill PFE 153.00 $153.00
BIA Bio -Elec Im ed Anal 14.00 $14.0 0
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.
PFT W/Interp $33.00 $33.00
Audiameta $14.00 $14.OD
ECG W/ Interp $20.00 $20.00
Urinalysis Dipstick $3.00 $3.00
Tonometry $36.00 $36.00
HB SAb Quantitative Titer $35.00 $35.00
PSA $35.00 $35.0 0
Hemoccult $5.00 $5.00
Schoeff Jr. Donald D. No -Show Fee $0.00 $0.00
Troyer, Darin M. Comprehensive Physical $91.Do $91.0 0
Health Risk Appraisal Motivation 16.00 $1 6.00
O nMed Pro ram $0.00 $0.
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
Vital Signs HT WT BP P R $7.00 $7.00
Vision Titmus $26.00 $26.00
PFT W/Interp $33.00 $33.00
INVOICE
0 Public Safety Medical Services
324 E. New York Street
as
Suite 300
W Indianapolis, IN 46204
o Carmel Police Department 1 CARMEPC
3 Civic Square Terms
Carmel, IN 46032 Invoice Date 05/20/2009
m Invoice 00 -11092
Date Employee Description Amount Balance Due
Audiometry $14.00 $14.00
ECG WI Interp $20.00 $20.0 0
Urinalysis Dipstick $3.00 $3. 00
Tonometry $36,00 $36.00
VanNatter, Shane R. Com rehenslve Physical $91.00 $91,00
OnMed Program $0.00 $0.00
Health Risk Appraisal f Motivation 16.00 $16.0 0
Respirator/Medical Review $16.00 $16.0 0
Treadmill (PFE) $153.00 $153.00
Flexibilitv Check $10.00 $10.00
Waist/Hip Ratio 3. 0
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
Audiomet 14.00 $14.001
ECG W1 Interp $20.00 $20.00
Urinalysis Dipstick $3.00 $3.00
Tonornetry 536.00 $36.nn
Total Charges $3,254.00
Total Payments Balance Due $0.00 $3,254.00
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
PrescribO 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))
5/13/09 11053 pavment for officer physicals 257.00
11092 Davment for officer h sicals 3,254.00
Total J
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.
r
ALLOWED 20
P ublic Safety Medical Services IN SUM OF
324 E. New York Street, Suite 300
Indianapolis, IN 46204
3=;
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
DEEPT. P or INVOICE NO. ACCT #/TITLE AMOUNT
I hereby certify that the attached invoice {s or
1110 11053 407 -01 257.00 bill (s) is (are) true and correct and that the
1110 11092 407 -01 3,254.00 materials or services itemized thereon for
which charge is made were ordered and
received except
May 21 20 09
�ga
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
f—
INVOICE
M Public Safety Medical Services
324 E. New York Street
E Suite 300
Indianapolis, IN 46204
C Carmel Fire Department 1 CARMEFD
2 Civic Square Terms
Carmel, IN 46032 Invoice Date 05/20/2009
Invoice 00 -11091
Date Employee Description Amount Balance Due
05/11/09 Ray, Lucas M. HB SAb Quantitative Titer $35.00 $35.00
Watts Trent E. HB SAb Quantitative Titer $35.00 35.00
Total Charges $70.00
Total Payments Balance Due $0.00 1 $70.00.
Please write invoice number on payment check.
Our Federal Employer Identification Number is 35- 2079797
VOUCHER NO. WARRANT NO,
ALLOWED 20
Pubic Safety Medical Services
IN SUM OF
324 East New York Street, Ste. 300
Indianapolis, IN 46204
$70.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members
1120 11091 43- 407.02 $70.00 I 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
LJ0
r
Fire Chief
Title
Cost distribution ledger classificatlon 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))
11091 $70.00
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
2a
Clerk- Treasurer