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Home My WebLink About221105 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 367222 Page 1 of 1 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLc HECK AMOUNT: $28,987.29 CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHICAGO IL 60686-0020 CHECK NUMBER: 221105 CHECK DATE: 6/18/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 724075 707 . 00 TESTING FEES 301 5023990 724646 4 , 457 . 63 OTHER EXPENSES 301 5023990 725316 4, 374 . 16 OTHER EXPENSES 301 5023990 725318 19, 448 . 50 OTHER EXPENSES 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 June 3, 2013 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Misc.Onsite/May 2013 1 Civic Square Carmel, IN 46032- ��___ ------Invoice# 724646 Proc Code Service Date Description Quantit Charge Receipt Adiust Balance 99070 05/12/2013 Young at Heart Clinic Meds 1.00 4,457.63 4457.63 CITYCARO Invoice# 724646 Balance Due: 4457.63 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLUDE INVOICE#ON CHECK D Q � JUN 17 2013 i By Cut and return with pavment Indiana University Health Workplace Services, LLC 4850N( Century Plaza Rd. WP-City nfCarmel Indianapolis, IN 46254-5477 317'216-2828 Tax|D# 20'0934452 Invoice June 3. 2O13 Bill to: Barbara Lamb For: City nfCarmel '0noi/c City of Carmel '0nairc 0nobc Fees/May 28|] | Civic Square Carmel, IN 46032' lnvoioo# 725316 C mc�ud: �u�ue J�� D�ud�b� Qumz�t Cbu�e 6es�� &�u� Bmbuu�xKw8V|L 05N|/2O|3 Ci�o[Cu,mn|C|ioicBuiN0m |.OV 2.574.|V z574.\O »0wLCxS 05/01/2013 City o[Curmc|Sports Performance 1.00 1.800.00 1800.00 L,xoc C|TYCxK0 Invoice# 7%53}6 Balance Due: Q4374.1 MAKE PAYMENT T0THE BBL0YV ADDRESS WITHIN 30 DAYS OF INVOICE DATE' PLEASE INCLUDE INVOICE#0N CHECK JUN 17 2013 avinent � c Indiana University Health Workplace Services, LLC �1 4850 W. Century Plaza Rd. WP-City of Carmel Indianapolis, IN 46254-5477 317-216-2828 Tax I D# 20-0994452 Invoice June 3, 2013 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Nurse Time/May 2013 1 Civic Square Carmel, IN 46032- 1 Invoice# 72531.8 Proc Code Service Date Description Quantit Charge Receipt Adjust Balance 05/09/2013 CONTRACT R.N. DAY 6.00 372.00 372.00 Given Kopecky 05/10/2013 CONTRACT R.N. DAY 10.75 666.50 666.50 Given Kopeck-_i 05/13/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 05/13/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopecky 05/14/2013 CONTRACT R.N. DAY 6.00 1,050.00 1050.00 Dr. Fagan 05/14/2013 CONTRACT R.N. DAY 6.00 372.00 372.00 Given Kopecky 05/14/2013 CONTRACT R.N. DAY 6.00 168.00 168.00 Lanie Blinn 05/15/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 05/15/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopecky 05/15/2013 CONTRACT R.N. DAY 5.00 140.00 140.00 Lanie Blinn 05/16/2013 CONTRACT R.N. DAY 4.00 700.00 700.00 Dr. Fagan 05/16/2013 CONTRACT R.N. DAY 4.00 248.00 248.00 Given Kopec6y 05/16/2013 CONTRACT R.N.DAY 4.00 112.00 112.00 Lanie Blinn 05/17/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr. Fagan 05/17/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopecky 05/17/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Lanie Blinn E 0 2013 .............. Invoice# 725318 (continued)page 2 Proc Code Service Date Description Quantit Charge Receipt Ad ust Balance 05/20/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 05/20/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Given Kopecky 05/20/2013 CONTRACT R.N. DAY 5.00 140.00 140.00 Lanie Blinn 05/21/2013 CONTRACT R.N. DAY 6.00 1,050.00 1050.00 Dr. Fagan 05/21/2013 CONTRACT R.N. DAY 6.00 372.00 372.00 Given Kopecky - 05/21/2013 CONTRACT R.N.DAY 6.00 168.00 168.00 Lanie Blinn 05/22/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 05/22/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopecky 05/22/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Lanie Blinn 05/23/2013 CONTRACT R.N. DAY 4.00 700.00 700.00 Dr. Fagan 05/23/2013 CONTRACT R.N.DAY 4.00 248.00 248.00 Given Kopecky 05/23/2013 CONTRACT R.N. DAY 4.00 112.00 112.00 Lanie Blinn 05/24/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 05/24/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopecky 05/24/2013 CONTRACT R.N. DAY 5.00 140.00 140.00 Lanie Blinn 05/28/2013 CONTRACT R.N. DAY 6.00 1,050.00 1050.00 Dr. Fagan 05/28/2013 CONTRACT R.N. DAY 6.00 372.00 372.00 Given Kopecky 05/28/2013 CONTRACT R.N.DAY 6.00 168.00 168.00 Lanie Blinn 05/29/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 05/29/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopecky 05/29/2013 CONTRACT R.N. DAY 5.00 140.00 140.00 Lanie Blinn 05/30/2013 CONTRACT R.N. DAY 4.00 700.00 700.00 Dr. Fagan 05/30/2013 CONTRACT R.N. DAY 4.00 248.00 248.00 Given Kopecky 05/30/2013 CONTRACT R.N. DAY 4.00 112.00 112.00 Lanie Blinn Invoice# 725318(continued)page 3 Proc Code Service Date Description Quantit Charge Receiat Adjust Balance 05/31/2013 CONTRACT R.N. DAY 5.00 875.00 875.00 Dr. Fagan 05/31/2013 CONTRACT R.N. DAY 5.00 310.00 310.00 Given Kopeckv 05/31/2013 CONTRACT R.N. DAY 5.00 140.00 140.00 Lanie Blinn CITYCARO Invoice# 725318 Balance Due: 19448.50 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLUD INVOICE#ON CHECK I q D JUIV 17 2013 1 By Cut and return with payment ..�°------ 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)) 06/03/13 724646 Mise O—nsite (May) , W63/4-3— 725318 1, min Tomp Total $28,280.29 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 NODet _WARRANT NO. ALLOWED 20 111 Health WnrknlacP ServicPS, I L.0 IN SUM OF $ 2046 Reliable Pkwy f"`hiraon IL 60686-01020 $ $28,280---29 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 724646 301 $4,457.63 materials or services itemized thereon for 725316 $4,374.16 which charge is made were ordered and 725318-- $19 AAR 5 received except 20 sign re Title Cost distribution ledger classification if claim paid motor vehicle highway fund Indiana University Health Workplace Services, LLC �� 4850 W Century Plaza Rd. WP General Onsite Indianapolis, IN 46254-5477 317-216-2828 Tax I D# 20-0994452 Invoice June 3, 2013 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Onsite/May 2013 1 Civic Square Carmel, IN 46032- __ Invoice# .724075Jr Proc Code Service Date Description Quantit Charge Receipt Adjust Balance 05/06/2013 Quick Read UDS/6panel 15.00 D Q JUN 17 2013 By Invoice# 724075 (continued)page 2 Proc Code Service Date Description Quantit Charge Receipt Adjust Balance 05/06/2013 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit 15.00 Invoice# 724075 (continued)page 3 Proc Code Service Date Description Quantit Charge Receipt Adiust Balance 05/06/2013 Quick Read UDS/6panel 15.00 kit 15.00 Invoice# 724075 (continued)page 4 � _ Proc Code Service Date Description uantit Charge vReceipt Adjust Balance 05/08/2013 Quick Read UDS/6panel includes 22.00 Invoice# 724075 (continued)page 5 Proc Code Service Date Description Quantit Charge Receint Adjust Balance 82075 05/07/2013 Evidential Breath-Reg. 707.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE IN LUDE INVOICE#ON CHECK Lr- D JUN 17 2013 j By + ^th oavment 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)) 06/03/13 724075 $707.00 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 VOUCHER NO. WARRANT NO. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $707.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 724075 I I 43-588.00 I $707.00 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 Monday, June 17, 2013 r Direct r, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund