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Home My WebLink About208432 04/25/2012 \,f CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $2,023.69 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 y�.. INDIANAPOLIS IN 46204 CHECK NUMBER: 208432 CHECK DATE: 4/25/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340702 17670 39.73 SHOTS INOCULATIONS 1110 4340701 17672 978.79 MEDICAL EXAM FEES 1110 4340701 26090 17672 675.19 EXAM FOR APPLICANT 1110 4340701 17740 329.98 MEDICAL EXAM FEES INVOICE F Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 04/17/2012 m Invoice 00 -17740 Date Employee Description Amount Balance Due 04/10/12 Semester James S. 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 PSA Prostate Specific A Blood 36.59 $36.59 04/13/12 Foster Johnathan A. Quantiferon Tb Blood $52.28 $52.28 CMP (Como Metabolic Panel 20.01 20.01 CBC Corn Blood Count $18.12 $18.12 Pane (Blood) Veni uncture $3.14 $3.14 HIV 1 2 Blood 13.59 $13.59 PSA Prostate Specific A Blood $36.59 $36.59 Total Charges $329.98 Total Payments Balance Due $0.00 $329.98 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from Invoice date INVOICE 40 Public Safety Medical Services r 324 E. New York Street E Suite 300 W. Indianapolis, IN 46204 C Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 04/11/2012 m Invoice 00 -17672 Date Employee Description Amount Balance Due 04/02/12 Navarrete Juan Chart Review/Completion $84.67 $84.67 Indiana PERF Exam $190.28 $190.28 Tb Review Hx Positive Questionnaire $0.00 $0.00 Applicant Blood Panel PERF $120.04 $120.04 Drug Screen 7 GC /MS W /MRO $41.82 $41.82 Veni uncture $3.14 $3.1 4 Vision Color Farnsworth 27.18 $27.18 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity 27.18 $27.18 Vision Color Ishihara 27.18 $27.18 PT PI n nfo Test $34.50 $34 Audiometry $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 Tonomet Glaucoma Test 37.64 $37.64 Scott Curtis D. Quantiferon Tb Blood 52.28 $52.28 CMP (Comp Metabolic Panel 20.01 $20.01 CBC (Comp Blood Count 18.12 $18.1 2 Li id Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.141 HIV 1 2 Blood 13.59 $13.59 PSA Pr'ostate Specific A Blood 36.59 $36.59 VanN tter. Shane R. Quantiferon T BI ood) $52.28 $52.2 CMP (Comp Metabolic Panel $20.01 $20.01 CBC (Comp Blood Count $18.12 $18.12 Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 2 Blood $13.59 $13.59 PSA Prostate Specific A Blood 36.59 $36.59 04/03/12 Bickel Scott W. Quantiferon Tb Blood 52.28 $52.28 CMP (Comp Metabolic Panel 20.01 $20.01 CBC (Comp Blood Count 18.12 $18.1 2 Li id Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV Blood 13 1 Dunlap, Christopher T. Quantiferon Tb Blood $52.28 $52.28 CMP (Comp Metabolic Panel $20.01 $20.01 CBC (Comp Blood Count $18.12 $18.12 Lipid Panel Blood $21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 2 Blood $13.59 $13.59 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 Muscular Stren th Endurance Test $27.18 $27.18 x IBM I 343 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 a) W Indianapolis, IN 46204 C Carmel Police Department CARMEPD f 3 Civic Square Terms Carmel, IN 46032 Invoice Date 04/1112012 m Invoice 00 -17672 Date Employee Description Amount Balance Due Flexibility Test $10.46 $10.46 Body Fat Test BIA Bio -Elec Im Anal 14.64 $14.64 Wais Hi Ratio $3.14 $3.1 4 Treadmill Su bmax $159.90 $159.9 Vital Signs HT WT BP P R $0.00 $0.00 Vision Acuity $27.18 $27.18 PFT Pulmonary Function Test $34.50 34.50 Audiometry $14.64 $14.64 F=1 EKG W1 Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.1 4 Total Charges $1.653.98 Total Payments Balance Due $0.00 $1,653.98 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from Invoice date r INS Oil I i mom INDIANA RETAIL TAX EXEMPT PAGE C ��CERTIFICATE NO. 003120155 002 0 Y PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT i 35- 60000972 NE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P Cf =L, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM AI !BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. I I 'URCHASE ORDER TE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 3193192 t J I Pubil� i Hadici►i Soci Cmrmol Polico Dopadmont VENDOR SHIP 3 Civic Squam 324 M. II I t York StroA Suite 3M TO Cs2Pi IN i Indi�n��boll�, IN AM 4397} 5�'9 CONFIRMATION BLANK =T CONTRACT PAYMENTTERMS FREIGHT QUANTITY g� UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 43 4 7.® A 9 Each psi physical for applicant $575.19 $575.19 Sum Total: $575.19 V gy a I s 1 gi Juan Wayarmto ..vg Send Invoice To:�� Cool Police Dopartment Alan: TI Anderson 3 Civic Square Carnal, IN 4I PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT Carmel Police DW. PAYMENT W75.19 A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. y C.O.D. SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY SHIPPING LABELS. Chitdi of Police THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE- AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK TREASURER DOCUMENT CONTROL NO. 2 6 ®9 A.P.V. COPY SIGN AND RETURN TO CLERIC'S OFFICE VOUCHER NO....,.._____.._..-. WARRANT ALLOWED 20 IN THE SUM OF t f I ON ACCOUNT OF APPROPRIATION FOR A u t Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT I hereby certify that the attached invoice(s), or Wi bills is are true and correct and that the materials or services itemized thereon for .s which charge is made were ordered and received except 20 Signature Title Cost distribution, 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)) 04/11/12 17672 officer physicals $978.79 04/11/12 17672 psych physical for applicant $675.19 04/17/12 17740 officer physicals $329.98 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 $1,983.96 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 17672 43- 407.01 $978.79 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 26090 17672 43- 407.01 $675.19 materials or services itemized thereon for 1110 17740 43- 407.01 $329.98 which charge is made were ordered and received except Thursday, April 19, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 m W Indianapolis, IN 46204 o Carmel Fire Department CARMEFD Attn: Accounts Payable Terms Invoice Date 04/11/2012 2 Civic Square m Carmel, IN 46032 Invoice 00 -17670 Date Employee Description Amount Balance Due 04/02/12 Greiner Brandon J. Hep B Titer SAb Quantitative Blood 36.59 $36.59 Veni uncture $3.14 $3.14 Total Charges $39.73 Total Payments &Balance Due $0.00 $39.73 Please write invoice number on payment check. Balance due 15 days from Our Federal Employer Identification Number is 35- 2079797 Invoice 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 note attached invoice(s) or bill(s)) 17670 $39.73 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. WAR NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $39.73 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 I 17670 I 43- 407.02 I $39.73 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 PR d 3 2012 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund