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Home My WebLink About223994 09/10/2013 CITY OF CARMEL, INDIANA VENDOR: 367222 Page 1 of 1 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLC CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK AMOUNT: $35,162.02 '. � CHICAGO IL 60686-0020 CHECK NUMBER: 223994 ICON GO CHECK DATE: 9/10/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 731463 788 . 00 TESTING FEES 301 5023990 731509 1, 114 . 86 OTHER EXPENSES 301 5023990 731520 28, 885 . 00 OTHER EXPENSES 301 5023990 731631 4, 374 . 16 OTHER EXPENSES Indiana University Health Workplace Services, LLC 950 North Meridian Street 120 1 Suite 200 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice September 3, 2013 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite/August 2013 1 Civic Square Carmel,IN 46032- Invoice# 731463 Proc Code Service Date Description Quanti Charge Reeeiot Ad'us Balance -------------------------------------- ---—-------------- —-------—------- 08/13/2013 Quick Read UDS/6panel 15.00 kit D Q � SEP 09 2013 By Invoice# 731463 (continued)page 2 Proc Code Service Date Descriotio Quanti Charge 15.00 Invoice# 731463 (continued)page 3 Proc Code Service Date Description Quanti Charge Receipt Adjust Balance 08/06/2013 Quick Read UDS/6panel 22.00 Invoice# 731463 (continued)page 4 Proc Code Service Date Description 22.00 Invoice# 731463 (continued)page 5 Proc Code Service Date Descdptio Quanti Charge Recei t Adjust Balance 08/07/2013 Quick Read UDS/6panel INCLUDE INVOICE#ON CHECK w - Cut and return with payment 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)) 09/03/13 731463 Onsite $788.00 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. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $788.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 I 731463 I 43-588.00 I $788.00 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, September 09, 2013 Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax I D# 20-0994452 Invoice September 3, 2013 Bill to: Barbara Lamb For: City of Carmel- Onsite City of Carmel- Onsite Nurse Time/August 2013 1 Civic Square Carmel,IN 46032- Invoice# 731520 Proc Code Service Date Description Quanti Charge Reeiot Adjust Balance 08/01/2013 CONTRACT R.N.DAY 4.00 700.00 700.00 Dr.Fagan 08/01/2013 CONTRACT R.N.DAY 4.00 248.00 248.00 Gwen Kopecky 08/01/2013 CONTRACT R.N.DAY 4.00 112.00 112.00 Jennifer Lawson 08/02/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan 08/02/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Gwen Kopecky 08/02/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/05/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan 08/05/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Gwen Kopecky 08/05/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/06/2013 CONTRACT R.N.DAY 6.00 1,050.00 1050.00 Dr.Fagan 08/06/2013 CONTRACT R.N.DAY 6.00 372.00 372.00 Given Kopecky 08/06/2013 CONTRACT R.N.DAY 6.00 168.00 168.00 Jennifer Lawson 08/07/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan 08/07/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Given Kopecky 08/07/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/08/2013 CONTRACT R.N.DAY 4.00 700.00 700.00 Dr. Fagan L� D SE; 0 9 2013 1 By Invoice# 731520(continued)page 2 Proc Code Service Date Description Quantit Charge Receipt AAdust Balance 08/08/2013 CONTRACT R.N.DAY 4.00 248.00 248.00 Gwen Kopecky 08/08/2013 CONTRACT R.N.DAY 4.00 112.00 112.00 Jennifer Lawson 08/09/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan 08/09/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Given Kopecky 08/09/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/12/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan 08/12/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/12/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Gwen Kopecky 08/13/2013 CONTRACT R.N.DAY 6.00 1,050.00 1050.00 Dr.Fagan 08/13/2013 CONTRACT R.N.DAY 6.00 168.00 168.00 Jennifer Lawson 08/13/2013 CONTRACT R.N.DAY 6.00 372.00 372.00 Gwen Kopecky 08/14/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan 08/14/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/14/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Given Kopecky 08/15/2013 CONTRACT R.N.DAY 4.00 700.00 700.00 Dr.Fagan 08/15/2013 CONTRACT R.N.DAY 4.00 112.00 112.00 Jennifer Lawson 08/15/2013 CONTRACT R.N.DAY 4.00 248.00 248.00 Given Kopecky 08/16/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan 08/16/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/16/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Gwen Kopecky 08/19/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan 08/19/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/19/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Gwen Kopecky 08/20/2013 CONTRACT R.N.DAY 6.00 1,050.00 1050.00 Dr.Fagan Invoice# 731520(continued)page 3 Proc Code Service Date Description Quanti Charge Receipt Adjust Balance 08/20/2013 CONTRACT R.N.DAY 6.00 168.00 168.00 Jennifer Lawson 08/20/2013 CONTRACT R.N.DAY 6.00 372.00 372.00 Given Kopecky 08/21/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan 08/21/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/21/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Given Kopecky 08/22/2013 CONTRACT R.N.DAY 4.00 700.00 700.00 Dr.Fagan 08/22/2013 CONTRACT R.N.DAY 4.00 112.00 112.00 Jennifer Lawson 08/22/2013 CONTRACT R.N.DAY 4.00 248.00 248.00 Gwen Kopecky 08/23/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan 08/23/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/23/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Given Kopecky 08/26/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan 08/26/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/26/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Gwen Kopecky 08/27/2013 CONTRACT R.N.DAY 6.00 1,050.00 1050.00 Dr.Fagan 08/27/2013 CONTRACT R.N.DAY 6.00 168.00 168.00 Jennifer Lawson 08/27/2013 CONTRACT R.N.DAY 6.00 372.00 372.00 Gwen Kopecky 08/28/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan 08/28/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/28/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 ` Gwen Kopecky 08/29/2013 CONTRACT R.N.DAY 4.00 700.00 700.00 Dr.Fagan 08/29/2013 CONTRACT R.N.DAY 4.00 112.00 112.00 Jennifer Lawson 08/29/2013 CONTRACT R.N.DAY 4.00 248.00 248.00 Gwen Kopecky 08/30/2013 CONTRACT R.N.DAY 5.00 875.00 875.00 Dr.Fagan Invoice# 731520(continued)page 4 Proc Code Service Date Description Quanti Charge Receipt Adjust Balance 08/30/2013 CONTRACT R.N.DAY 5.00 140.00 140.00 Jennifer Lawson 08/30/2013 CONTRACT R.N.DAY 5.00 310.00 310.00 Gwen Kopecky CITYCARO Invoice# 731520 Balance Due: 28885.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUD INVOICE#ON CHECK �„�. Cut and return with payment Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) -3o) Indianapolis, IN 46204 317-963-1535 Tax I D# 20-0994452 Invoice September 3, 2013 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/August 2013 1 Civic Square Carmel,IN 46032- Invoice# 731509 Proc Code Service Date Descril2tion Quanti Charge Receiot Adiust Balance 99070 07/31/2013 Young at Heart Clinic Meds 1.00 354.56 354.56 99070 08/01/2013 Onsite Lab Charges 1.00 760.30 760.30 Judy 2013 Labs CITYCARO Invoice# 731509 Balance Due: l 114. MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK D Za a SE-F092013 , i By �� Cut and return with payment Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice September 3, 2013 Bill to: Barbara Lamb For: City of Carmel- Onsite City of Carmel- Onsite Onsite Fees/August 2013 1 Civic Square Carmel,IN 46032- Invoice# 731631 Proc Code Service Date Description Quanti Charge Receiot A&Us Balance CARMBUIL 08/01/2013 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16 CARMLEAS 08/01/2013 City of Carmel Sports Performance 1.00 1,800.00 1800.00 Lease CITYCARO Invoice# 731631 Balance Due: 4374.]6 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK =.� 0 9 2013 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)) 09/03/ Misr- Onsite Fees (Aug) 1 1A.86 09/03/43 T3,63, nsite Fees (Aug) 41374-16 Total 34,374.02 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 3—WARRANT NO. -:Z 7 722-- ALLOWED 20 U Health Workplace Services, LLC IN SUM OF $ 2046 Reliable Pkwy Chiracin, 11 6068-6-0020 $ $34,374-02 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 :':�o 1 731520 $28,885.00 materials or services itemized thereon for 731509 inj $1,114.86 which charge is made were ordered and received except 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund