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Home My WebLink About214790 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES a 1' CHECK AMOUNT: $3,316.03 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 INDIANAPOLIS IN 46204 CHECK NUMBER: 214790 CHECK DATE: 11/20/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 19024 25 . 00 MEDICAL FEES 1120 4340701 19120 62 . 73 MEDICAL EXAM FEES 1091 4340700 19121 65 . 00 MEDICAL FEES 1110 4340701 19122 418 . 16 MEDICAL EXAM FEES 1110 4340701 19159 164 . 99 MEDICAL EXAM FEES 1120 4340701 19209 221 . 20 MEDICAL EXAM FEES 1110 4340701 19210 2, 358 . 95 MEDICAL EXAM FEES INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 it Indianapolis, IN 46204 G Carmel Clay Parks & Recreation/CARMELPARK 1411E 116th Street Terms Carmel, IN 46032 Invoice Date 10/17/2012 m Invoice# 00-19024 Date Employee Description Amount Balance Due 10/08/12 Strong, Gail C. HB SAb Quantitative Titer $25.00 $25.00 Veni uncture $0.00 $0.00 Total Charges-> $25.00 Total Payments&Balance Due > $0.00 1 $25.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 Purchase P.O.# PorF BuAloet �� I� Line Descr Pu chaser - 1'`�'"� Date � Z OCT 1 � 2012 :�ro,al Data BY. INVOICE to Public Safety Medical Services w 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 =- o Carmel Clay Parks & Recreation/CARMELPARK 0 1411 E 116th Street Terms NOV ® 5 21 V Carmel, IN 46032 Invoice Date 11/01/2012 m Invoice# 00-19121 BY: Date Employee Description Amount Balance Due 10122/12 Ran.Kim A. Hepatitis B Vaccination#3 $65.00 $65.00 In ection Fee $0.00 0.00 Total Charges-> $65.00 Total Payments&Balance Due-> $0.00 $65.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 Balance due 15 days from invoice date Description P.O.# P or�7F r G.L.# Budget S Line Descr Purchaser to Approval U 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 $ 25.00 10/17/12 19024 Medical fees $ 65.00 11/1/12 19121 Medical fees Total $ 90.00 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$ $ 90.00 ON ACCOUNT OF APPROPRIATION FOR 108 - ESE & 109 Monon Center PO#or INVOICE NO. ACCT#MTLE AMOUNT Board Members Dept# 1081-99 19024 4340700 $ 25.00 1 hereby certify that the attached invoice(s), or 1091 19121 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 15-Nov 2012 Signature $ 90000 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD H Attn: Accounts Payable Terms 2 Civic Square Invoice Date 11/01/2012 m Carmel, IN 46032 Invoice# 00-19120 Date Employee Description Amount Balance Due 10/23/12 1 Freer Keith T. Repeat Chest X-Ray PA/LAT $62.73 $62.73 Total Charges > $62.73 Total Payments&Balance Due > $0.00 $62.73 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 Balance due 15 days from invoice date INVOICE 0 Public Safety Medical Services = 324 E. New York Street E Suite 300 M Indianapolis, IN 46204 G Carmel Fire Department/CARMEFD Attn: Accounts Payable Terms 2 Civic Square Invoice Date 11/14/2012 m Carmel, IN 46032 Invoice# 00-19209 Date Employee Description Amount Balance Due 11/08/12 Thompson,James L. Fitness For Duty Exam Initial Level 2 $179.38 $179.38 Drug Screen 7 GUMS W/MRO $41.82 $41.82 Total Charges-> $221.20 Total Payments&Balance Due-> $0.00 $221.20 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 Nhom, 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)) 19209 $221.20 19120 $62.73 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. WARRANT NO. ALLOWED 20 Public Safety Medical Services IN SUM OF $ 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $283.93 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members r - 1120 19209 43-407.01 $221.20 1 hereby certify that the attached invoice(s), or 1120 19120 43-407.01 $62.73 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 NOV 19 7012 / � r i Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE ►0 Public Safety Medical Services 324 E. New York Street E Suite 300 W W Indianapolis, IN 46204 G Carmel Police Department/CARMEPD �- Terms 3 Civic Square Carmel, IN 46032 Invoice Date 11/01/2012 100 Invoice# 00-19122 Date Employee Description Amount Balance Due 10/22/12 White.Kari E. 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 Flexibility Test $10.46 $10.4 6 Body Fat Test-BIA Bio-Elec Imp Anal 14.64 $14.64 Waist/Hi Ratio $3.14 $3.1 4 Tonomet Glaucoma Test 37.64 $37.64 Vital Si ns-HT WT BP P R $0.00 $0.00 T-Pulmon Function Test $34.50 $34.50 Audiometry $14.64 $14.64 EKG W/Interp $20.91 $20.91 urinal sis-Dipstick $3.14 $3.141 Total Charges-> 1 $418.16 Total Payments&Balance Due-> $0.00 $418.16 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 Balance due 15 days from invoice date INVOICE H Public Safety Medical Services .. 324 E. New York Street E Suite 300 � Indianapolis, IN 46204 C Carmel Police Department/CARMEPD F— 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11!08/2012 m Invoice# 00-19159 Date Employee Description Amount Balance Due 10/31/12 Keith Brett 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 Ag CpLoodL 36.59 36.59 Total Charges-> $164.99 Total Payments&Balance Due > $0.00 $164.99 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 Balance due 15 days from invoice date INVOICE 0 Public Safety Medical Services 324 E. New York Street E Suite 300 x Indianapolis, IN 46204 o Carmel Police Department/CARMEPD �- Terms 3 Civic Square Carmel, IN 46032 Invoice Date 11/14/2012 m Invoice# 00-19210 Date Employee Description Amount Balance Due 11/05/12 Barlow Cody 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 Bickel Joseph E. Quantiferon-Tb Blood 52.28 $52.28 CMP(Comn Metabolic Panel 20.01 $20.01 CBC(Comp Blood Count 18.12 $18.12 Li id Panel Blood 21.26 $21.26 Veniounct r $3.14 $3.14 HIV 1 &2 Blood $13:59 $13.59 PSA-Prostate Specific A Blood $36.59 $36.59 Cash Steven H. 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 Graham Bruce A. 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 BI ood) $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 McAllister John W. Quantiferon-Tb Blood 52.28 $52.28 CMP(Comp Metabolic Panel 20.01 $20.01 CBC(Comp Blood Count 18.12 $18.121 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 Rice Jonathan Tb Skin Test $7.32 $7.3 2 Chart Review/Comoletion $84.67 $84.67 Indiana PERF Exam $190.28 1 $190.28 Applicant Blood Panel-PERF $120.04 $120.04 Veni uncture $3.14 $3.14 Drug Screen 7 GC/MS W/MRO $41.82 $41.82 Chest X-Ra -PA/LAT(Digital) 62.73 $62.73 Vital Signs-HT WT BP P R $0.00 0.00 Vision-Acuity 27.18 $27.18 Vision-Color Ishihara 27.18 $27.18 PFT-Pulmonary Function Test $34.50 $34.50 Audiometry 14.64 $14.64 EKG W/Intero $20.91 1 20.91 INVOICE 4o Public Safety Medical Services 324 E. New York Street E Suite 300 X Indianapolis, IN 46204 C Carmel Police Department/CARMEPD F- Terms 3 Civic Square Carmel, IN 46032 Invoice Date 11/14/2012 m Invoice# 00-19210 Date Employee Description Amount Balance Due Urinalysis-Di stick $3.14 $3.14 Tonomet (Glaucoma Test 37.64 $37.64 11/06/12 Me er Ryan J. Quantiferon-Tb Blood 52.28 $52.28 P Metabolic P 1 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 11/09/12 Bay.Christopher A. Chart Review/Completion $84.67 $84.67 Indiana PERF Exam $190.28 $190.28 Applicant Blood Panel-PERF $120.04 $120.0 4 Drug Screen 7 GC/MS W/MRO $41.82 $41.82 Veni uncture 3.14 $3.14 Chest X-Ra v-P LAT(Digital) 62.73 $62.73 Vital Si ns-HT WT BP P R $0.00 $0.00 Vii on-Acuity 7.1 $27.18 Vision-Color Ishihara $27.18 $27.18 PFT-PulmonarV Function Test $34.50 $34.50 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 Tb Skin Test $7.32 $7.32 Howard Lana M. Quantiferon-Tb Blood 52.28 $52.28 CMP(Comp Metabolic Panel 20.01 $20.01 CBC(Comn Blood Count 18.12 $18.12 Lipid Panel Blood 21.26 $21.26 Venipuncture $3.14 4 HIV 1 &2 Blood $13.59 $13.59 Total Charges-> $2,358.95 Total Payments&Balance Due-> $0.00 $2,358.95. 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)) 11/01/12 19122 officer physical $418.16 11/08/12 19159 officer physical $164.99 11/14/12 19210 officer physical $2,358.95 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 $2,942.10 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 19122 43-407.01 $418.16 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 19159 43-407.01 $164.99 materials or services itemized thereon for 1110 19210 43-407.01 $2,358.95 which charge is made were ordered and received except Thursday, November 15, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund