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Home My WebLink About209312 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $3,377.30 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 L o INDIANAPOLIS IN 46204 CHECK NUMBER: 209312 CHECK DATE: 5122/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 17908 65.00 MEDICAL FEES 1091 4340700 17908 65.00 MEDICAL FEES 1110 4340701 17909 3,247.30 MEDICAL EXAM FEES INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Clay Parks Recreation CARMELPARK 1411 E 116th Street Terms Carmel, IN 46032 Invoice Date 05/10/2012 m Invoice 00 -17908 Date Employee Description Amount Balance Due 05/01/12 Ran Kim A. Hepatitis B Vaccination #2 $65.00 $65.0 0 Infection Fee $0.00 $0.00 Simpson, Brea J. Hepatitis B Vaccination #2 $65.00 $65.0 0 In ection Fee $0.00 $0.00 Total Charges $130.00 Total Payments Balance Due $0.00 $130.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 a, ,AI 1. 4 Purchase Description P.O.# PorF .L. Budget Line Descr h Puroas a z Approval Date /OR -99- V3 VD �00 /O 91- �3/O7 0D 0 o 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 5/10/12 17908 Medical fees 65.00 5/10/12 17908 Medical.fees 65.00 Total 130.00 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 130.00 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1081 -99 17908 4340700 65.00 1 hereby certify that the attached invoice(s), or 1091 17908 4340700 65.00 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 17 -May 2012 P4VW1 Signature 130.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE 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 05/10/2012 m Invoice 00 -17909 Date Employee Description Amount Balance Due 04/30/12 Goldstein Seth B. Tb Read $0.00 $0.00 05/01/12 Batic Zachary J. No Show Fee $40.00 $40.00 Govin John K. 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 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 T nomet (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 Harting, Charles V. OnMed Program $0.00 so.001 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Flexibility Test $10.46 $10.46 Body Fat Test BIA Bi -EI c Imp Anal 14.4 $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 AcuitV $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 In ection Fee $10.46 $10.4 6 Td Tetanus Di htheria Vacc $20.91 $20.911 Hood. L. OnMed Pro r m $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 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 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 m W Indianapolis, IN 46204 O Carmel Police Department/ CARMEPD f' 3 Civic Square Terms Carmel, IN 46032 Invoice Date 05/10/2012 m Invoice 00 -17909 Date Employee Description Amount Balance Due Audiometry 14.64 $14.64 EKG W/ Inter 20.91 $20.91 Urinalysis Di stick $3.14 $3.14 Pelzer, Robert S QnMad Health Risk Appraisal Motivation $0.00 $0.00 Respirator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.461 Flexibilit Test $10.46 $10.46 Body Fat Test BIA Bio -Elec Imp Anal 14.64 $14.64 WaisUft Ratio $3.14 $3.14 Treadmill Submax $159.90 $159.90 Tonomet Glaucoma Test 37.64 $37.64 Vital Si ns HT WT BP P R $0.00 $0.00 Vision Acuity 27.18 $27.18 PFT Pulmonary Function Test $34.50 $34.50 Audiometry $1 .64 $14 EKG W/ Interp $20.91 $20.91 Urinalysis Dipstick $3.14 $3.14 hection Fee $10.46 $10.46 Td Tetanus Diphtheria) Vacc $20.91 $20.91 Renforth Trevor 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 Muscular Strength Endurance Test $27.18 $27.18 Flexibility Test $10.46 $10.46 Body Fat Test BIA Bi -EI c Imp An I 14 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 $0.00 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 Urinal sis Dipstick $3.14 $3.14 Schoeff Jr. Donald D. OnMed Program $0.00 $0.00 Health Risk A raisal Motivation 0.00 $0.00 Res irator /Medic I Review $16.73 $16.73 C omprehensive Physical Exam .$102.45 1 2.46 Flexibilitv Test $10.46 $10.46 Body Fat Test BIA Bio -Elec Imp Anal $14.64 $14.64 WaisUft Ratio $3.14 $3.141 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 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Police Department CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 05/10/2012 m Invoice 00 -17909 Date Employee Description Amount Balance Due PFT Pulmonary Function Test $34.50 $34.50 Audiornetry $14.64 $14.64 EKG W/ Interp $20.91 $20.91 Urinal sis Dipstick $3.14 $3.14 Smith Troy D. 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 Flexibilitv Test $10.46 $10.4 6 Body Fat Test BIA Bio -Elec Imp Anal 14.64 $14.64 Waist/Hip Ratio .14 $3.14 Treadmill Submax $159.90 $159.90 Tonomet Glaucoma Test $37.64 $37.64 Vital Si ns 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 Total Charges $3,247.30 Total Payments Balance Due $0.00 $3,247.30 Please write invoice number on payment check. Our Federal Employer Identification Number is 35- 2079797 VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $3,247.30 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 17909 I 43- 407.01 I $3,247.30 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 Friday, May 18, 2012 Chief of Police 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)) 05/10/12 17909 officer physicals $3,247.30 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