214409 11/07/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES CHECK AMOUNT: $380.52
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300
a� INDIANAPOLIS IN 46204 CHECK NUMBER: 214409
CHECK DATE: 11/7/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 19079 380 . 52 MEDICAL EXAM FEES
INVOICE
F Public Safety Medical Services
= 324 E. New York Street
E Suite 300
W Indianapolis, IN 46204
o Carmel Police Department/CARMEPD
F- 3 Civic Square Terms
Carmel,IN 46032 Invoice Date 10129!2012
M Invoice# 00-19079
Date Employee Description Amount Balance Due
10/15/12 Myers,Brady R. OnMed Pro ram $0.00 $0.00
Health Risk Anpraisal Motivation 0.00 $O.OD
Respirator/Medical Review $16.73 $16.73
Comprehensive Physical Exam 102.46 $102.46
Treadmill-Submax $159.90 $159.90
Flexibility Test $10.46 1 4
Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64
Waist/Hi Ratio $3.14 $3.1 4
Vital P 0.00 $0.00
PFT-Pulmonary F unr
,fion Test $34.50 1 34.5
Audipmetcy $14.64 4
EKG W/Inter $20.91 $20.91
Urinalysis-Dipstick $3.14 11.14
Total Charges-> $380:52
Total Payments&Balance Due $0.00 $380.52
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 E. New York Street, Suite 300
Indianapolis, IN 46204
$380.52
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 I 19079 I 43-407.01 I $380.52 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
Friday, November 02, 2012
F 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))
10/29/12 19079 officer physical $380.52
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