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Home My WebLink About221838 07/11/2013 CITY OF CARMEL, INDIANA VENDOR: 367222 Page 1 of 1 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLIiHECK AMOUNT: $35,532.14 CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHICAGO IL 60686-0020 CHECK NUMBER: 221838 CHECK DATE: 7/11/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 729650 26, 282 . 00 OTHER EXPENSES 301 5023990 729695 4, 875 . 98 OTHER EXPENSES 301 5023990 730707 4 , 374 . 16 OTHER EXPENSES Indiana University Health Workplace Sorviueo, LLC 485UVV. Century Plaza Rd. ��_- WP-City o/Carmel Indianapolis, IN 46254'5477 | 317'216-2828 ` Tax|D# 20'0994452 Invoice July 1. 2013 ` Bill to: Barbara Lamb For: City o[Carmel '0nobc City of Cunnc '0nake Nurse l\nne/]unc2O|3 I Civic Square Carmel, ON460]2- '-----'-'--�------- ----'' ---' ' '---' '---------- ----- --- -'-- '---- ----------- -----'------ invoioe# 729650 | --------------- ---------------------- '----------'---'-'----- ---------------- - 2roc lCode Service Date Descriptio o Quantit Charge Beceii) 8ALU-St Balance 06m3/2013 C0NTRACTu.N. DAY 5.00 875.00 875.00 Dr. Fagan � 06/03/2013 CmvTxxCTK.w. DAY 4.00 2*8.00 248.00 0wvnK"r«oky 06/03/2013 C0wTKACru.N. DAY ]jO 98.00 98.00 Lunmabxn 06/04/2013 CVNTV&CTK.N. DAY 6.00 1,050.00 1050.00 Dr. Fagan 0004/2013 C0Nlx^CTK.w. DAY 5.00 310.00 310.00 nwvnxip,xky 0004/2013 CONTRACT x.N. DAY 7.50 21000 210.00 Luom8/m/, 06/05/2013 C0NTxaCTx.N. DAY 5.00 875.00 875.00 Dr. Fagan 06/05/2013 CVNTxACTK.N. DAY 4.00 248.00 24&00 G`voo«"veckp � 06/05/2013 C0NTKACTR.N. DAY 5.25 147.00 147.00 lvva8h*n � 06/06/2013 CONTRACT K.N.DAY 4.00 700.00 700.00 Dr. Fagan 06/06/2013 C0NTKAC7u.N. DAY 5.00 310.00 310.00 | G`««nKvr'ckr | 06/06/2013 C0wTKAC7x.N. DAY 5.00 140.00 140.00 LunaB0n/, 06/07/2013 CONTRACT x.N. DAY 5.00 875.00 875.00 Dr. Fagan 06/07/2013 CONTRACT K]~. DAY 4.00 248.00 248.00 0wo»Kvr««kv 06/07/2013 CONTRACT K.N.DAY 6.00 168.00 168.00 conaa0on V6/|O/z0|33 c0vTxACTx.N. DAY 5.00 875.00 875.00 Dr. Fagan JUL I a' 2013 � � � Invoice# 729650(continued)page 2 Proc Code Service Date Description Quantity Charge Receipt Adjust Balance 06/10/2013 CONTRACT R.N. DAY 4.00 248.00 248.00 Given Kopeck) 06/10/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Lanie Blinn 06/11/2013 CONTRACT R.N. DAY 6.00 1,050.00 1050.00 Dr. Fagan 06/11/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Given Kopecky 06/11/2013 CONTRACT R.N.DAY 6.50 182.00 182.00 Lanie Blinn 06/12/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 06/12/2013 CONTRACT R.N. DAY 4.00 248.00 248.00 Given Kopecky 06/12/2013 CONTRACT R.N. DAY 5.75 161.00 161.00 Lanie Blinn 06/13/2013 CONTRACT R.N. DAY 4.00 700.00 700.00 Dr. Fagan 06/13/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopeckv 06/13/2013 CONTRACT R.N. DAY 5.00 140.00 140.00 Lanie Blinn 06/14/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 06/14/2013 CONTRACT R.N. DAY 4.00 248.00 248.00 Given Kopecky 06/14/2013 CONTRACT R.N. DAY 6.00 168.00 168.00 Lanie Blinn 06/17/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopecky 06/17/2013 CONTRACT R.N. DAY 5.00 140.00 140.00 Lanie Blinn 06/17/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 06/18/2013 CONTRACT R.N. DAY 6.00 372.00 372.00 Given Kopecky 06/18/2013 CONTRACT R.N. DAY 6.00 168.00 168.00 Lanie Blinn 06/18/2013 CONTRACT R.N.DAY 6.00 1,050.00 1050.00 Dr. Fagan 06/19/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopecky 06/19/2013 CONTRACT R.N. DAY 5.00 140.00 140.00 Lanie Blinn 06/19/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 06/20/2013 CONTRACT R.N. DAY 4.00 248.00 248.00 Given Kopecky Invoice# 729650(continued)page 3 Proc Code _._ Service Date Description Quantit Charge Recei t Adiust Balance 06/20/2013 CONTRACT R.N. DAY 4.00 112.00 112.00 Lanie Blinn 06/20/2013 CONTRACT R.N. DAY 4.00 700.00 700.00 Dr. Fagan 06/21/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopecky 06/21/2013 CONTRACT R.N. DAY 5.00 140.00 140.00 Lanie Blinn 06/21/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 06/24/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopecky 06/24/2013 CONTRACT R.N. DAY 5.00 140.00 140.00 Lanie Blinn 06/24/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 06/25/2013 CONTRACT R.N. DAY 6.00 372.00 372.00 Gwen Kopecky 06/25/2013 CONTRACT R.N. DAY 6.00 168.00 168.00 Lanie Blinn 06/25/2013 CONTRACT R.N.DAY 6.00 1,050.00 1050.00 Dr. Fagan 06/26/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopeckv 06/26/2013 CONTRACT R.N. DAY 5.00 140.00 140.00 Lanie Blinn 06/26/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 06/27/2013 CONTRACT R.N.DAY 4.00 248.00 248.00 Given Kopecky 06/27/2013 CONTRACT R.N. DAY 4.00 112.00 112.00 Lanie Blinn 06/27/2013 CONTRACT R.N. DAY 4.00 700.00 700.00 Dr. Fagan 06/28/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopeck), 06/28/2013 CONTRACT R.N. DAY 5.00 140.00 140.00 Lanie Blinn 06/28/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr. Fagan CITYCARO Invoice# 729650 Balance Due: 26282.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLUDE INVOICE#ON CHECK Cutand---- with payment ® Please remit 26,282.00 and Make Check Payable to: ❑ VISA INVOICE# 729650 1U Health Workplace Services, LLC ❑ MASTERCARD 2046 Reliable Pkwy Chicago, IL 60686-0020 ACCOUNTNO CSV ESP CODE DATE Phone: 317-216-2880 SIGNATURE AMOUNT PAID Indiana University Health Workplace Services, LLC 4850 W. Century Plaza Rd. WP-City of Carmel Indianapolis, IN 46254-5477 317-216-2828 Tax ID# 20-0994452 Invoice July 1, 2013 Bill to: Barbara Lamb For: City of Carmel -Onsite 'City of Carmel - Onsite Misc.Onsite/June 2013 1 Civic Square Carmel, IN 46032- ____....__..._.. Invoice# 729695 Proc Code y Service Date Description Quantity Charge Receipt Adjust Balance 99070 05/19/2013 Young at Heart Clinic Meds 1.00 467.03 467.03 99070 05/26/2013 Young at Heart Clinic Meds 1.00 373.62 373.62 99070 05/31/2013 Young at Heart Clinic Meds 1.00 2,267.92 2267.92 99070 06/01/2013 Onsite Lab Charges 1.00 196.37 196.37 May 2013 Labs 99070 06/10/2013 Young at Heart Clinic Meds 1.00 1,571.04 1571.04 CITYCARO Invoice# 729695 Balance Due: 4875.98 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLUDE INVOICE#ON CHECK Cut and rehire with payment Please remit 4,875.98 and Make Check Payable to: VISA INVOICE# 729695 IU Health Workplace Services, LLC OW MASTERCARD 2046 Reliable Pkwy Chicago,IL 60686-0020 ACCOUNT NO CSV ExP Phone: 317-216-2880 CODE DATE SIGNATURE AMOUNT PAID $ 4 �-`7,�- Indiana University Health Workplace Services, LLC 4850 W. Century Plaza Rd. WP-City of Carmel Indianapolis, IN 46254-5477 317-216-2828 Tax I D# 20-0994452 Invoice July 1, 2013 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Onsite Fees/June 2013 1 Civic Square Carmel, IN 46032- _� _.._._._._.._�.. �_._.._.__....._. _. ._._.._Invoice# 730707 Proc Code Service Date Description Quantit Charge Receipt Adjust Balance CARMBUIL 06/01/2013 City of Cannel Clinic Build Out 1.00 21574.16 2574.16 CARMLEAS 06/01/2013 City of Carmel Sports Performance 1.00 1,800.00 1800.00 Lease CITYCARO Invoice# 730707 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLUDE INVOICE#ON CHECK Cut and return with payment --------------------------------------------------------------------------------------------------------------------------------- Please remit 4,374.16 and Make Check Payable to: F]�!? VISA IU Health Workplace Services,LLC INVOICE# 730707 ❑ MASTERCARD 2046 Reliable Pkwy Chicago, IL 60686-0020 ACCOUNT NO CsV EXP ICODE DATE Phone: 317-216-2880 SIGNATURE AMOUNT PAID Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995) 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 IU Health Workplace Services, LLC Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 07/01/13 729650 Staff 2 07/01/13 729695 Health Center Rx 07/01/13 730707 Lease and Build Out Total $35,532.14 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 N007/01/13 WARRANT NO. IU Health Workplace Services, LLC ALLOWED 20 IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $ $35,532.14 ON ACCOUNT OF APPROPRIATION FOR 301 Medical Fund 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 729650 $26,282.00 materials or services itemized thereon for 729695 4,875.98 which charge is made were ordered and 730707 4,374.16 received except 20 CL Signature Title Title Cost distribution ledger classification if claim paid motor vehicle highway fund