The URL can be used to link to this page

Home My WebLink About208842 05/10/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $5,611.13 INDIANAPOLIS IN 46204 CHECK NUMBER: 208842 IOM GQ, CHECK DATE: 5/10/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 17791 65.00 MEDICAL FEES 1110 4340701 17792 4,499.33 MEDICAL EXAM FEES 1110 4340701 17851 371.61 MEDICAL EXAM FEES 1110 4340701 26091 17951 675.19 EXAMS FOR APPLICANT INVOICE 40 Public Safety Medical Services 324. E. New York Street E Suite 300 W Indianapolis, IN 46204 a Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 04/24/2012 m Invoice 00 -17792 Date Employee Description Amount Balance Due 04/16/12 Harting, Charles V. 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 PSA Prostate Specific A Blood 36.59 $36.59 Pelzer, Robert S. Quantiferon Tb Blood 52.28 $52.28 CMP (Comp Metabolic Panel $20.01 $20.01 CBC (Comp Blood Count 18.12 $18.12 Lind Panel Blood 21.26 $21.26 Veni n t re $3.14 $3.14 HIV 1 2 Blood $13.59 $13.59 PSA Prostate Specific A Blood 36.59 $36.59 Pitman. Michael A. Quantiferon Tb Blood $52.28 $52.28 CMP (Comp Metabolic Panel $20.01 $20.01 CBC (Comp Blood Count 18.12 $18.1 2 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 Schoeff Jr. Donald D. Quantiferon Tb Blood 52.28 $52.28 CMP Com Metabolic Panel 20.01 $20.01 B 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 04/19/12 Bickel Scott W. Tonometr Glaucoma Test 37.64 $37.64 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 EKG W/ Intern $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 OnMed Program $0.00 $0.00 H ealth Risk r i I (Motivation) $0. 0 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Flexibility Test $10.46 $10.46 Bodv Fat Test BIA Bio -Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill Submax $159.90 $159.90 Foster Johnathan A. OnMed Program $0.00 $0.00 Health Risk Anoraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 a: Indianapolis, IN 46204 G Carmel Police Department CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 04/24/2012 m Invoice 00 -17792 Date Employee Description Amount Balance Due Flexibility Test $10.46 $10.46 Body Fat Test BIA Bio -Elec Im Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.1 4 Treadmill Submax $159.90 1 Tonomet Glaucoma Test $37.64 $37.64 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 Audiornetry $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 Hood Bryan L. Quantiferon Tb Blood $52.28 $52.28 CMP Conn Metabolic Panel 20.01 $20.01 CBC (Comp Blood Count 18.12 $18.1 2 Lipid Panel Blood 21.26 $21.26 Venipuncture $3.14 $3.14 HIV 1 2 Blood $13.59 $13.59 Jent Danny N. 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 PSA Prostate Specific A Blood 36.59 $36.59 OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator /Medical Review $16.73 $16.73 Co mprehensive P i l Exam 11 $102.4 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 Treadmill Submax $159.90 $159.90 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 Audiornetry $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 Pitman Michael A. OnMed Program $0.00 $0.00 H ealth Risk Appraisal (Motivation) 0 0 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 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 Treadmill Submax 159.90 159.90 Tonometr Glaucoma Test 37.64 $37.64 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 04/24/2012 CD Invoice 00 -17792 Date Employee Description Amount Balance Due 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 AudiometrV $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Di stick $3.14 $3.14 Scott. Curtis D. 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 Mj!ag ular Strength Endurance Test $27.18 $27.1 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 Treadmill Submax $159.90 $159.90 Tonomet Glaucoma Test 37.64 $37.64 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 EKG W/ Interp 20.91 $20.91 Urinalysis Di stick $3.14 $3.14 Semester, Jam S. OnMed Program 0. Health Risk Appraisal Motivation $0.00 $0.00 Res irator /Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 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 Treadmill Submax $159.90 $159.9 0 Tonomet Glaucoma Test 37.64 $37.64 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 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 Stein. Amy J. OnMed Program $0.00 $0.00 Health Risk Appraisal (Motivation) $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Com rehensive Physical Exam $102.46 $102.46 Muscular Strength Endurance Test $27.18 $27.18 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 Treadmill Submax 159.90 159.90 INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 04/24/2012 m Invoice 00 -17792 Date Employee Description Amount Balance Due 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. $14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 VanNatter, Shane R. 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 Muscular Strength Endurance Test $27.18 1 $27.18 Flexibility Test $10.46 $10.461 Body Fat Test BIA Bio -Elec Im o Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.14 Treadmill Submax $159.90 $159.90 Tono et (Glaucoma Test) 7. 37.64 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 EKG W/ Interp 1 $20.91 $20.91 Urinalysis Dipstick 1 $3.14 $3.14 Total Charges $4,499.33 Total Payments Balance Due $0.00 $4,499.33 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)) 04/24/12 17792 officer physicals $4,499.33 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 E. New York Street, Suite 300 Indianapolis, IN 46204 $4,499.33 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1110 I 17792 I 43- 407.01 I $4,499.33 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 Wednesday, May 02, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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 05/03/2012 m Invoice 00 -17851 Date Employee Description Amount Balance Due 04/25/12 Govin John K. CBC (Comp Blood Count 18.12 $18.12 Li id Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 Quantiferon Tb Blood 52.28 $52.28 CMP (Comp Metabolic Panel 20.01 $20.01 04/26/12 Smith Troy 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 Lipid Panel Blood 21.26 $21.261 Veni uncture $3.14 $3.14 V1 1 04/27/12 Goldstein, Seth B. Chart Review/Completion $84.67 $84.67 Indiana PERF Exam $190.28 Applicant Blood Panel PERF $120.04 $120.04 Drug Screen 7 GC/MS W /MRO U$27.18 1.82 41.82 Veni uncture 3.14 3.14 Tb Skin Test 7.32 7.32 Chest X -Ray PA/LAT (Digital) 2.73 62.73 Vital Signs HT WT BP P R 0.00 0.00 Vision Acuity $27.181 Vision Color Ishihara 27.18 $27.18 PFT Pulmonary Function Test $34.50 $34.50 Audiomet $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 1 $3.14 Tonomet Glaucoma Test 37.64 $37.64 Renforth Trevor M. Veni uncture $3.14 $3.14 HIV 1 2 Blood 13.59 $13.59 Quantiferon Tb Blood 52.28 $52.28 CMP (Comp Metabolic Panel 20.01 $20.01 CBC (Comp Blood Count 18.12 $18.1 2 Lipid Panel Blood 21.26 21.26 TotalCharges-> $1;046.80 Total Payments &`Balance Due $0.00 $1,046.80 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 Balance due 15 days from Invoice date INDIANA RETAIL TAX EXEMPT PAGE C i ®f Carmel CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 2 mi 35- 60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE. FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 DURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 319592 Public @If NodicEl Somicche Camol Eclico DepzAment VENDOR SHIP 3 Civic Sgum M E. NGvj Ycd4 Streot, Sulto TO Cmrmcl, IN Indianapolis, IN 4M (397) 671 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY I UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 43- 107.09 9 Each psych physical for appliemni $676.1 $673.19 Sub T $673.19 f paa c A- both G ®ldstoin Send Invoice To: Carmel Police Dopor$mant Attn: TOrosa Andorson 3 Civic 6qum Carmo1, IN 4 PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Carmel Police Dept. c PAYMENT $675.19 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. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY SHIPPING LABELS. i g Chlof g O? Pollco THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE'-. AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK TREASURER 2 DOCUMENT CONTROL NO A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO._ WARRANT NO.—___ ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. 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____ 20 Signature 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)) 05/03/12 17851 officer physicals $371.61 05/03/12 17951 applicant physical psych $675.19 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 VOU NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $1,046.80 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. I ACCT #/TITLE AMOUNT Board Members 1110 17851 43- 407.01 $371.61 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 26091 17951 43- 407.01 $675.19 materials or services itemized thereon for which charge is made were ordered and received except Friday, May 04, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE t° Public Safety Medical Services 324 E. New York Street F Suite 300 a> X Indianapolis, IN 46204 o Carmel Clay Parks Recreation CARMELPARK 1411 E 116th Street Terms Carmel, IN 46032 Invoice Date 04/24/2012 m Invoice 00 -17791 Date Employee Description I Amount Balance Due 04/19/12 Ra endran Shru hee Hepatitis B Vaccination #3 $65.00 $65.00 In ection Fee $0.00 0.00 Total Charges 1 $65.00 Total Payments Balance Due $0.00 1 $65.00 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35- 2079797 date Purchase �y A PR 2 h Description Il P.O.# PorF G.L.# ��1 -9g y3y 700 Budget ,7 6� S Line Descr Purchaser Approval Data 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 4/24/12 17791 Medical fees 65.00 Total 65.00 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 65.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1081 -99 17791 4340700 65.00 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 3-May. 2012 M72M'l Signature 65.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund