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Home My WebLink About207201 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $2,382.37 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 «o INDIANAPOLIS IN 46204 CHECK NUMBER: 207201 CHECK DATE: 3/13/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4340700 16784 25.00 MEDICAL FEES 1110 4340701 17265 256.80 MEDICAL EXAM FEES 1120 4340701 17324 15.00 MEDICAL EXAM FEES 1110 4340701 17325 2,085.57 MEDICAL EXAM FEES INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 d b� Indianapolis, IN 46.204 o Carmel Clay Parks Recreation CARMELPARK Terms 1411E 116th Street Invoice Date 12/2212011 m Carmel, IN 46032 Invoice 00 -16784 Date Employee gescription, Amount Balance•Due, j 12/14/11 Raver Jordan L. HB SAb Quantitative Titer $25.00 $25.00 Veni uncture $0.00 0.00 ,Total Charges $25:00;. Total,Pe',ments &.Balance >Due 'c 30.00 $25:00 Please write invoice number on payment check. i Our Federal Employer Identification Number is 35- 2079797 FEB 2 2 2012 BY i Purchase G cription t_!' P or F/, q Lj ca V O G. L. ll J S I {budget Line Descr vc� at Z 12 Z4 12- Purchase Date___ ppprovat ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 00350364 Public Safety Medical Services Terms 324 E. New York Street, Ste 300 Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 12/22/11 16784 Medical fees 25.00 Total 25.00 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. 00350364 Public Safety Medical Services Allowed 20 324 E. New York Street, Ste 300 Indianapolis, IN 46204 In Sum of 25.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members Dept 1091 16784 4340700 25.00 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 8 -Mar 2012 I Signature 25.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE F- 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 O Carmel Police Department CARMEPD I-' Terms 3 Civic Square Carmel, IN 46032 Invoice Date 02123/2012 C3 Invoice 00 -17265 Date Employee Description Amount Balance Due 02/13/12 Hasty, Zachery R. Quantiferon Tb Blood $52.28 $52.28 CMP (Comp Metabolic Panel $20.01 $20.01 CBC (Comp Blood Count $18.12 $18.12 Li id Panel Blood $21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 2 Blood 13.59 $13.59 02(16(12 Loveall Gregory A. Quantiferon Tb Blood 52.28 $52.28 CMP (Como Metabolic Panel 20.01 $20.01 CBC (Comp Blood Count 18.12 $18.12 Li id Panel Blood 21.26 $21.26 VQniouncture S314 14 HIV 1 2 Blood $13.59 $13.59 To Charg $256.80 Total Payments Balance Due $0.00 $256.80 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 d W Indianapolis, IN 46204 C Carmel Police Department CARMEPD t 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02/29/2012 m Invoice 00 -17325 Date Employee Description Amount Balance Due 02/24/12 Bodenhorn Wendy M. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Treadmill Submax $159.90 $159.90 Flexibility Test $10.46 $10.4 6 Body Fat Test BIA Bio -Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Tonomet Glaucoma Test 37.64 $37.64 Vital Si ns HT WT BP P R $0.00 $0.001 Vision -A uity 7.1 27 1 Audiometry $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 Collins. Shane P. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Treadmill Submax $159.90 $159.90 Flexibility Test $10.46 $10.46 Body Fat Test BIA Bio -Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 nmt [y (Gl Tes 7.64 $37. Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity $27.18 $27.18 Audiometry $14.64 $14.64 EKG'W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 Hasty, Zachery R. No Show Fee Patient Sick 0.00 $0.00 Love 11. Gregory A. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator /Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 102.46 Treadmill Submax $159.90 $159.90 Flexibility Test $10.46 $10.461 Body Fat Test BIA Bio -Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Injection Fee 1 $10.46 $10.46 Td Tetanus Diphtheria) Vacc $20.91 $20.91 Tonomet Glaucoma Test 37.64 1 $37.64 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 27.18 $27.18 Audiometry 14.64 $14.64 EKG W/ Inter 20.91 20.91 Urinal sis Di stick $3.14 $3.14 Troyer, Darin M. OnMed Pro ram $0.00 1 so.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 d X Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 02/29/2012 m Invoice 00 -17325 Date Employee Description Amount Balance Due Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.4 6 Treadmill Sub max $159.90 $159.9 Flexibility Test $10.46 $10.46 Body Fat Test BIA Bio -Elec Imp Anal $14.64 $14.64 Waist/Hi Ratio $3.14 3.14 Tonomet Glaucoma Test $37.64 $37.64 Vital Signs HT WT BP P R $0.00 $0.0 0 Vision AcuitV $27.18 $27.18 AudiornetrV $14.64 $14.64 EKG W/ Intem $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 Williams Ashley L. OnMed Program $0.00 $0.00 Health Risk Aopraisal Motivation 0.00 $0.00 Re it t r dic I Review $16.73 1 $16.7 Comprehensive Ph sical Exam $102.46 $102.46 Treadmill Submax $159.90 $159.90 FlexibilitV Test $10.46 $10.46 Body Fat Test BIA Bio -Elec Imp Anal $14.64 $14.64 WaisUHi Ratio $3.14 $3.14 Tonomet Glaucoma Test 37.64 $37.64 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 27.18 $27.18 Audiometry 14.64 14.64 EKG W/ Intero $20. 20.91 Urinalysis Di stick $3.14 3.14 Total Charges $2,085.57 Total Payments Balance Due $0.00 $2,085.57 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date 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)) 02/23/12 17265 officer physicals $256.80 02/29/12 17325 officer physicals $2,085.57 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 $2,342.37 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1110 17265 43- 407.01 $256.80 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 17325 43- 407.01 $2,085.57 materials or services itemized thereon for which charge is made were ordered and received except Friday, March 09, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 a Carmel Fire Department CARMEFD f Attn: Accounts Payable Terms Invoice Date 02/29/2012 2 Civic Square m Invoice 00 -17324 Carmel, IN 46032 Date Employee Description Amount Balance Due 02/24/12 Alverson Jonathan L. Medical Records Request 15.00 1 $15.00 Total Charges 1 $15.00 Total Payments Balance Due $0.00 1 $15.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date 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)) 17324 $15.00 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 Public Safety Medical Services IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $15.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 I 17324 I 43- 407.01 I $15.00 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 MAR 12 2012 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund