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Home My WebLink About211432 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $10,472.73 y�•'o CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 211432 CHECK DATE: 7/31/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4340701 24358 18475 6, 269 . 09 PHYSICALS 1110 4340701 18476 1, 068 . 16 MEDICAL EXAM FEES 1120 4340701 24358 18515 249 . 43 PHYSICALS 1110 4340701 18516 2, 886 . 05 MEDICAL EXAM FEES INVOICE H Public Safety Medical Services w 324 E. New York Street E Suite 300 M Indianapolis, IN 46204 C Carmel Police Department/CARMEPD �- 3 Civic Square Terms Carmel, IN 46032 Invoice Date 07/25/2012 m Invoice# 00-18516 Date Employee Description Amount Balance Due 07/16/12 Mabie.Michael L. 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 $3.1 4 PSA-Prostate Specific A Blood 36.59 $36.59 07120112 Byrne, Timothy L. OnMed Program $0.00 0.00 Health Risk Appraisal Motivation 0.00 $0.00 Res irator/Medical Review $16.73 $16.73 Comprehensive Physical Exam $102.46 $102.46 Quantiferon-T BI $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 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 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 27.1 27.1 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry j$20.91 64 $14.64 EKG W/Inter .91 20.91 Urinalysis-Dipstick .14 $3.14 In ection Fee .46 10.46 Td Tetanus Diphtheria)Vacc $20.91 Gauthier Edward B. OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 so.001 Respirator/Medical Review $16.73 16.73 Comprehensive Physical Exam $102.46 $102.46 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA(Bio-Elec Imp AnalO $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 $0.00 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 Urinal sis-Dipstick $3.14 $3.14 Harris Sarah E. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 $16.73 INVOICE Fo Public Safety Medical Services w 324 E. New York Street E Suite 300 Indianapolis, IN 46204 C Carmel Police Department/CARMEPD Terms 3 Civic Square Carmel, IN 46032 Invoice Date 07/25/2012 m Invoice# 00-18516 Date Employee Description Amount Balance Due Comprehensive 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 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-Dipstick $3.14 $3.14 In ection Fee $10.46 $10.4 6 Td Tetanus Diphtheria)Vacc $20.91 $20.91 Lovitt.Richard A. OnMed Program $0.00 $0.00 Health Risk Appraisal Motiv tion .0 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 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 Mabie Michael L. 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/Interlp $20.91 $20.91 Urinal sis-Dipstick $3.14 $3.14 OnMed Pro ram $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review 1 .7 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 Morrow.Scott A. OnMed Program $0.00 $0.00 Health Risk Appraisal Motivation 0.00 $0.00 Respirator/Medical Review $16.73 16.73 INVOICE F Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 . C Carmel Police Department/CARMEPD f— 3 Civic Square Terms Carmel, IN 46032 Invoice Date 07/25/2012 m Invoice# 00-18516 Date Employee Description Amount Balance Due 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 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 Inter 1 $20.91 Urinalysis-Dipstick $3.14 $3.14 Injection Fee $10.46 $10.46 Td Tetanus Diphtheria)Vacc $20.91 $20.91 Total Charges-> 1 $2,886.05 Total Payments&Balance Due-> $0.00 1 $2,886.05 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35-2079797 date INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 = Indianapolis, IN 46204 o Carmel Police Department/CARMEPD F- Terms 3 Civic Square Carmel, IN 46032 Invoice Date 07/18/2012 m Invoice# 00-18476 Date Employee Description Amount Balance Due 07/10/12 Amos Chad B. 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 Broadnax Matthew L. Quantiferon-Tb Blood 52.28 $52.28 CMP Com Metabolic Panel 20.01 $20.01 CBC(Como Blood Count 18.12 $18.1 2 Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 &2 BI ood) $13.59 $13.59 Collins,Larry J. 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 Harris Robert P. Quantiferon-Tb Blood 52.28 $52.28 CMP Com Metabolic Panel 20.01 $20.01 CBC(Como 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 PSA-Prostate Specific A Blood $36.59 $36.59 Ha maker William E. 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 $13.591 PSA-Prostate Specific A Blood 36.59 $36.59 S illman R. Scott Quantiferon-Tb Blood 52.28 $52.28 CMP(Como Metabolic Panel 20.01 $20.01 C o Blood Count) $18.12 $18.12 Li id Panel Blood $21.26 $21.26 Veni uncture $314 $3.14 HIV 1 &2 Blood $13.59 $13.59 PSA-Prostate Specific A Blood 36.59 $36.59 Vanderbeck. David R. Quantiferon-Tb Blood 52.28 52.28 CMP(Comp Metabolic Panel 20.01 $20.01 CBC(Comp Blood Count 18.12 $18.1 2 Lind 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 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 � Indianapolis, IN 46204 C Carmel Police Department/CARMEPD f' Terms 3 Civic Square Carmel, IN 46032 Invoice Date 07/18/2012 m Invoice# 00-18476 Date Employee Description Amount Balance Due Total Charges-> $1,068.16 Total Payments&Balance Due-> $0.00 $1,068.16 Please write invoice number on payment check. Balance due 15 days from invoice Our Federal Employer Identification Number is 35-2079797 date VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF $ 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $3,954.21 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 18476 43-407.01 $1,068.16 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 18516 43-407.01 $2,886.05 materials or services itemized thereon for which charge is made were ordered and received except Thursday, July 26, 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)) 07/18/12 18476 officer physicals $1,068.16 07/25/12 18516 officer physicals $2,886.05 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 INVOICE 0 Public Safety Medical Services w 324 E. New York Street E Suite 300 � Indianapolis, IN 46204 C Carmel Fire Department I CARMEFD Attn: Accounts Payable Terms 2 Civic Square Invoice Date 07/18/2012 m Carmel, IN 46032 Invoice# 00-18475 Date Employee Description Amount Balance Due 07/10/12 Baskerville Anthony 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 Buttler,James N. 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 Venipuncture $3.14 $3.14 Deitsch,Marc 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 Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 &2 Blood 13.59 $13.59 Force Jason S. CMP Com Metabolic Panel 20.01 $20.01 CBC(Comp Blood Count 18.12 $18.1 2 Lipid Panel Blood 21.26 $21.26 Veni un ture $3.14 $3.14 uantiferon-Tb Blood 52.28 $52.28 Foster.James P Qi ntif on-Th $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 Cholinesterase-RBC&Plasma Blood 47.05 $47.05 Holubik Steven W. Quantiferon-Tb Blood 52.28 $52.28 CMP Com Metabolic Panel 20.01 $20.01 CBC(Comp Blood Count 18.12 $18.1 2 Li id Panel Blood 21.26 $21.26 V ni ncture $3.14 $3.14 HIV 1 &2 Blood $13.59 $13.59 PSA-Prostate Specific A Blood $36.59 $36.59 Hughes,Chad L. 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 $21.261 Veni uncture $3.14 $3.14 HIV 1 &2 Blood 13.59 $13.59 PSA-Prostate S ecific A Blood 36.59 $36.59 Mason Bryan L. O.antiferon-Tb Blooa 52.28 $52.28 CMP Corn Metabolic Panel 20.01 $20.01 INVOICE Fo Public Safety Medical Services = 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD �- Attn: Accounts Payable Terms 2 Civic Square Invoice Date 07/18/2012 m Carmel, IN 46032 Invoice# 00-18475 Date Employee Description Amount Balance Due CBC(Como Blood Count 18.12 $18.12 Li id Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 &2 BI 13. PSA-Prostate Specific A Blood $36.59 $36.59 Robinson Mitchell L. 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 Quantiferon-Tb Blood 52.28 $52.28 CMP(Comp Metabolic Panel 20.01 $20.01 Steele Jeffrey A. Quantiferon-Tb Blood H52.28 52.28 CMP Com Metabolic Panel 20.01 20.01 CBC Com Blood Count 18.12 $18.12 Lipid Panel(Blood) 21.2 21 Veni uncture $3.14 $3.14 PSA-Prostate Specific A Blood $36.59 $36.59 Thordarson.Erik M. 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 Wendzel Jason D. Quantiferon-Tb Blood 52.28 $52.28 CMP Corn Metabolic Panel 20.01 $20.01 CBC Com Blood Count 18.12 $18.1 2 Lipid Panel Bl d 212 Veni uncture $3.14 $3.14 Woodburn Scott E. 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 07/11/12 Alverson Jonathan L. 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 1 (Blood) 1 1 . PSA-Prostate Specific A Blood $36.59 $36.59 Contino David M. 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 INVOICE �o Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD t- Attn: Accounts Payable Terms Invoice Date 07/18/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18475 Date Employee Description Amount Balance Due Dorsch James E. 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 1 &2 Blood 13.59 13.59 PSA-Prostate S ecifc A Blood 36.59 36.59 Ellison Christo her M. Quantiferon-Tb Blood 52.28 $52.28 CMP(Comp Metabolic Panel 20.01 $20.01 CBC (Coma-Blood Count 18.12 $18.12 Lipid Panel BI ood) $21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 &2 Blood 13.59 $13.59 Love Joseph B. 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 q$52.28.14 3.14 HIV 1 &2 Blood .59 13.59 PSA-Prostate Specific A Blood .59 36.59 Lux Michael T. Quantiferon-Tb Blood 52.28 CMP Com Metabolic Panel 0.01 20.01 B m Blood Count) $18.12 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 Maroon,Ernie R. Quantiferon-Tb Blood 52.28 $52.28 CMP(Comp Metabolic Panel 20.01 $20.01 CBC Com P Blood Count $18.12 $18.1 2 Lipid Panel Blood 21.26 $21.26 Veni uncture M36.59 3.14 HIV 1 &2 Blood 13.59 PSA-Prostate S ecific A Blood 36.59 Web Gr A. u n i ron-T B 2 CMP Com Metabolic Panel $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 Cholinesterase-RBC&Plasma Blood 47.05 $47.05 Workman William J. Quantiferon-Tb Blood 52.28 $52.281 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 INVOICE to- Public Safety Medical Services «. 324 E. New York Street m Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD t- Attn: Accounts Payable Terms Invoice Date 07/18/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18475 Date Employee Description Amount Balance Due HIV 1 &2 Blood 13.59 $13.59 PSA-Prostate S ecific A Blood 36.59 $36.59 07/12/12 Anderson Donovan C. Quantiferon-Tb Blood 52.28 $52.28 P m r)Metabolic Panel) $20.01 CBC Corn 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 Cholinesterase-RBC&Plasma Blood 47.05 $47.05 Bailey,Mark E. Quantiferon-Tb Blood 52.28 $52.28 CMP Com Metabolic Panel 20.01 $20.01 CBC Corn Blood Count 18.12 $18.12 Li id Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 B lood) $13.59 $13.59 PSA-Prostate Specific A Blood $36.59 $36.59 Brant Kenneth E. 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 Brisco. Michael D. Quantiferon-Tb Blood 52.28 $52.28 CMP Com Metabolic Panel 20.01 $20.01 CBC(Como Blood Count 18.12 18.12 i id Panel(Blood) 21.2 21 2 Veni uncture $3.14 $3.14 HIV 1 &2 Blood $13.59 $13.59 PSA-Prostate Specific A Blood $36.59 $36.59 Davis James M. 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 S ecific A Blood 36.59 $36.59 Freer Keith T. Quantiferon-Tb Blood 52.28 $52.28 MP(Corno(Corn Metabolic P I 1 CBC(Comp Blood Count $18.12 $18.12 Lipid Panel Blood $21.26 $21.26 Veni uncture $3.14 $3.14 PSA-Prostate Specific A Blood $36.59 $36.59 Frenzel Eric C. Quantiferon-Tb Blood 52.28 $52.281 CMP(Comp Metabolic Panel 20.01 $20.01 CBC(Comp Blood Count 18.12 18.12 INVOICE � Public Safety Medical Services = 324 E. New York Street E Suite 300 w Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD Attn: Accounts Payable Terms 2 Civic Square Invoice Date 07/1812012 Carmel, IN 46032 Invoice# 00-18475 Date Employee Description Amount Balance Due Lipid Panel Blood 21.26 $21.26 Veni uncture $3.14 $3.14 Frye,Steven R. 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 Cholinesterase-RBC&Plasma Blood 47.05 $47.051 Harrington,Adam C. Quantiferon-Tb Blood 52.28 $52.28 CMP(Como 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 Hutchison Brian P. Quantiferon-Tb Blood $52.28 52.28 CMP Com 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 $3.1 4 HIV 1 &2 Blood 13.59 $13.59 Knott Bruce A. Quantiferon-Tb Blood 52.28 $52.28 P(Comp.Metabolic Panel) 2 .0 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 Mead David L. Quantiferon-Tb Blood 52.28 $52.28 CMP(Como 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 S ecific A Blood 36.59 $36.59 Mori rt y.John F. Quantifemn-T (Blood) .2 2 CMP(Comp Metabolic Panel $20.01 $20.01 CBC(Como 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 Re nolds Shawn J. Quantiferon-Tb Blood 52.28 $52.28 CMP fComp 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 INVOICE r° Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD Attn: Accounts Payable Terms 2 Civic Square Invoice Date 07/18/2012 m Carmel, IN 46032 Invoice# 00-18475 Date Employee Description Amount Balance Due HIV 1 &2 Blood 13.59 $13.59 Schooler,Dustin D. Quantiferon-Tb Blood 52.28 $52.2 8 CMP Com Metabolic Panel 20.01 $20.01 Blood CBC(Comi) unt) $18.12 $18.1 2 Lipid Panel Blood $21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 &2 Blood 13.59 1 $13.59 Sharp,Adam C. Quantiferon-Tb Blood $52.28 $52.28 CMP(Comp Metabolic Panel 20.01 $20.01 CBC Com P 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 Small Thomas D. Quantiferon-Tb Blood 52.28 $52.28 P(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 VanVoorst Robert J. 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-Pr t to Specific (Blood) 9 Cholinesterase-RBC&Plasma Blood $47.05 $47.05 Young,Andrew S. Quantiferon-Tb Blood $52.28 $52.28 CMP(Comp Metabolic Panel 20.01 $20.01 CBC(Comp Blood Count $18.12 $18.12 Lipid Pane( Blood $21.26 $21.26 Veni uncture $3.14 $3.14 HIV 1 &2 Blood 13.59 E13.59 Total Charges-> $6,269.09 Total Payments&Balance Due-> $0.00 $6,269.09 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 W Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD F— Attn: Accounts Payable Terms Invoice Date 07/25/2012 2 Civic Square m Carmel, IN 46032 Invoice# 00-18515 Date Employee Description Amount Balance Due 07/12/12 Thompson,James L. Fit For Duty Exam Follow U Level 2 $179.38 $179.38 07/17/12 Thompson,James L. Tb Skin Test $7.32 $7.32 Chest X-Ray-PA/LAT(Digital) $62.73 $62.73 07120112 Ca shave Jeffrey A. Repeat Blood Panel N/C-Error At Lab 0.00 $0.00 PSA-Prostate Specific A Blood 0.00 0.00 Total Charges-> $249.43 Total Payments&"Balance Due-> $0.00 $249.43 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 Balance due 15 days from invoice date VOUCHER NO. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF $ 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $6,518.52 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 18475 43-407.01 j $6,269.09 ( hereby certify that the attached invoice(s), or 1120 18515 43-407.01 $249.43 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 JUL 3 0 2012 Fire Chief 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)) 18475 $6,269.09 18515 $249.43 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