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HomeMy WebLinkAbout225867 11/05/2013 ±yF CITY OF CARMEL, INDIANA VENDOR: 367222 Page 1 of 1 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LLIiHECK AMOUNT: $53,417.29 ?o CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHICAGO IL 60686-0020 CHECK NUMBER: 225867 CHECK DATE: 11/5/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 731987 75 . 00 TESTING FEES 1201 4358800 731999 45 . 00 TESTING FEES 301 5023990 732030 29, 545 . 00 OTHER EXPENSES 301 5023990 732067 4 , 374 . 16 OTHER EXPENSES 301 5023990 732112 16, 215 . 84 OTHER EXPENSES 301 5023990 732156 3 , 162 . 29 OTHER EXPENSES Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 317-963-1535 64� Tax ID# 20-0994452 Invoice November 1, 2013 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Onsite/Oct. 2013 1 Civic Square Carmel, IN 46032- Invoice# 731987 Proc Code Service Date Description Quantity Charge Receipt Adjust Balance 10/08/2013 Quick Read UDS/6panel INCLUDE INVOICE#ON CHECK Cut and retum 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)) 11/01/13 731999 onsite testing fees $45.00 11/01/13 731987 onsite testing fees $75.00 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 $120.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. I ACCT#!TITLE AMOUNT Board Members 1201 731999 43-588.00 $45.00 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1201 731987 43-588.00 $75.00 materials or services itemized thereon for which charge is made were ordered and received except Monday, November 04, 2013 6—) - Ac"'t, 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 Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice November 1, 2013 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Onsite Fees/Oct.2013 1 Civic Square Carmel, IN 46032- �_� Invoice# 732067 Proc Code Service Date Description Quantity Charge Receipt Adjust Balance CARMBUIL 10/01/2013 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16 - CARMLEAS 10/01/2013 City of Carmel Sports Performance 1.00 1,800.00 1800.00 Lease CITYCARO Invoice# 732067 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLUDE INVOICE#ON CHECK D z NOV 4 2013 By -Cut and return with payment Please remit 4,374.16 and Make Check Payable to: �� VISA INVOICE# 732067 IU Health Workplace Services, LLC MASTERCARD 2046 Reliable Pkwy Chicago,IL 60686-0020 ACCOUNT NO CSV EXP Phone: 317-963-1535 ICODE DATE SIGNATURE AMOUNT AID Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice November 1, 2013 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Supply Billing/Oct. 201 1 Civic Square Carmel, IN 46032- .�___...__._ Invoice# 732112 - Proc Code Service Date Description Quantity Charge Receipt Adjust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 18.00 18.00 O.,vgen 99070 10/01/2013 Onsite Operating Supplies 1.00 60.00 60.00 Oxygen Refills 99070 10/01/2013 Onsite Operating Supplies 1.00 30.60 30.60 Biowaste 99070 10/01/2013 Onsite Operating Supplies 1.00 152.34 152.34 HANDHELD GUAGE/BULB SPHYGA40 LL/I 99070 10/01/2013 Onsite Operating Supplies 1.00 93.98 93.98 BANDAGE STAT-STRIP BUGS/DAFF1%8 99070 10/01/2013 Onsite Operating Supplies 1.00 171.88 171.88 BOOK ISHIHARA VISION TEST/I 99070 10/01/2013 Onsite Operating Supplies 1.00 22.27 22.27 PILLOWCASE DISPOSABLE 21 X3011 99070 10/01/2013 Onsite Operating Supplies 1.00 8.48 8.48 SYR 1 ML 27G A'.5IN/I 99070 10/01/2013 Onsite Operating Supplies 1.00 42.41 42.41 GLOVE NITRILE PF LF SA4 PUR16 99070 10/01/2013 Onsite Operating Supplies 1.00 24.00 24.00 ALCOHOL DISPENSER, PUSH DO1,VN/4 99070 10/01/2013 Onsite Operating Supplies 1.00 17.50 17.50 TAPE EYECULABEL DYA110 12 99070 10/01/2013 Onsite Operating Supplies 1.00 1,948.52 1948.52 ZOSTER VA CC LIVE 0.65A4L 11 99070 10/01/2013 Onsite Operating Supplies 1.00 292.01 292.01 KIT TEST FL U A AAID B 22/1 99070 10/01/2013 Onsite Operating Supplies 1.00 72.52 72.52 FORCEP NASAL PACKING 141ILDE/I 99070 10/01/2013 Onsite Operating Supplies 1.00 2.88 2.88 BASIN EA4ESIS ROSE 8.51A'120 99070 10/01/2013 Onsite Operating Supplies 1.00 13.56 13.56 NDL SA FT 25G 5181N/I Invoice# 732112 (continued)page 2 Proc Code Service Date Description Quantit Charge Receipt Adjust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 10.01 10.01 WIPE GERMICIDAL SANI-CLOTH LG/2 99070 10/01/2013 Onsite Operating Supplies 1.00 54.24 54.24 NDL SAFT 22GA A'1.5 IN/4 99070 10/01/2013 Onsite Operating Supplies 1.00 4.48 4.48 SPRA Y L YSOL FOAM 240Z11 99070 10/01/2013 Onsite Operating Supplies 1.00 197.82 197.82 THERM ORAL SYSTEM PKG A4690 4FT/I 99070 10/01/2013 Onsite Operating Supplies 1.00 7.36 7.36 TOURNIQUET NON-LATE,Y/I 99070 10/01/2013 Onsite Operating Supplies 1.00 6.07 6.07 SOAP LOTION LOBANA 16 OZ/1 99070 10/01/2013 Onsite Operating Supplies 1.00 44.22 44.22 TEST REAGENT CHEMSTRIP 10 14'/SG/1 99070 10/01/2013 Onsite Operating Supplies 1.00 3.66 3.66 MASK FACE PROCEDURE YEL/I 99070 10/01/2013 Onsite Operating Supplies 1.00 23.18 23.18 NDL HYPO 23GA/I IN/6 99070 10/01/2013 Onsite Operating Supplies 1.00 198.34 198.34 SET BLOOD COLLECT 23G 314 12IN14 99070 10/01/2013 Onsite Operating Supplies 1.00 25.80 25.80 CUFF BP ADULT LG LF SZ 1211 99070 10/01/2013 Onsite Operating Supplies 1.00 35.50 35.50 SYR 3CC LL 20GA171N16 99070 10/01/2013 Onsite Operating Supplies 1.00 67.03 67.03 PAPER COPY8 1/2 17 120 LB 12 99070 10/01/2013 Onsite Operating Supplies 1.00 67.91 67.91 ISHIHARA COLOR TEST 6-PLATE/1 99070 10/01/2013 Onsite Operating Supplies 1.00 109.13 109.13 SURE-VUE MONONUCLEOSIS TEST KT/1 99070 10/01/2013 Onsite Operating Supplies 1.00 0.79 0.79 BA7TALKA'PROCELL 9V/I 99070 10/01/2013 Onsite Operating Supplies 1.00 8.32 8.32 NOTE POST IT 3,V3 YEL/1 99070 10/01/2013 Onsite Operating Supplies 1.00 21.00 21.00 TABLET BLUING NO 100/1 99070 10/01/2013 Onsite Operating Supplies 1.00 4.67 4.67 SCISSOR IRIS FLR GR CVD 4.5IN/I 99070 10/01/2013 Onsite Operating Supplies 1.00 18.07 18.07 SNTZR HAND ALOE GEL 180Z 112 99070 10/01/2013 Onsite Operating Supplies 1.00 38.27 38.27 BIOFREEZE 32 OZ/1 99070 10/01/2013 Onsite Operating Supplies 1.00 3.74 3.74 MASK FACE PROCEDURE YEL/I 99070 10/01/2013 Onsite Operating Supplies 1.00 13.80 13.80 DRAPE ST FEN I8X26/1 99070 10/01/2013 Onsite Operating Supplies 1.00 3.86 3.86 TOWELETTE BZK CHLORIDE/I Invoice# 7321 12(continued)page 3 Proc Code Service Date Description Quantity Charge Recei t Adjust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 1.13 1.13 SOLN HYDRGN PEROXIDE 80Z12 99070 10/01/2013 Onsite Operating Supplies 1.00 42.43 42.43 PAPER ECIR THERMAL 18 99070 10/01/2013 Onsite Operating Supplies 1.00 16.09 16.09 141A TER PURE LIFE FROM HENRY SCH/3 99070 10/01/2013 Onsite Operating Supplies 1.00 14.17 14.17 PAPER COP)')'ELL01V HENRYSCHEIN/I 99070 10/01/2013 Onsite Operating Supplies 1.00 10.58 10.58 LIDOCAINE INJ 1%20,11,MD V/6 99070 10/01/2013 Onsite Operating Supplies 1.00 48.00 48.00 FORM PT SIGN IN SHEET PEEL OFF 11 99070 10/01/2013 Onsite Operating Supplies 1.00 4.49 4.49 NDL HYPO 22G 1-1/2/N/1 99070 10/01/2013 Onsite Operating Supplies 1.00 5.34 5.34 DSG SPONGE 4X4 NS 12PL)/1 99070 10/01/2013 Onsite Operating Supplies 1.00 10.51 10.51 PAD ALCOHOL PREP NS MED 16 99070 10/01/2013 Onsite Operating Supplies 1.00 14.16 14.16 NDL SA FT 25GA X IIN/1 99070 10/01/2013 Onsite Operating Supplies 1.00 20.74 20.74 BANDAGE STRIP 1X3IN/6 99070 10/01/2013 Onsite Operating Supplies 1.00 0.12 0.12 Carp:ject Plunger for PF Syr 1I0 99070 10/01/2013 Onsite Operating Supplies 1.00 34.85 34.85 FOLDER FILE HANGING BLU 12 99070 10/01/2013 Onsite Operating Supplies 1.00 34.85 34.85 FOLDER FILE HANGING BL U12 99070 10/01/2013 Onsite Operating Supplies 1.00 15.54 15.54 STRIP PO1,VER SURGE 3-4FT/I 99070 10/01/2013 Onsite Operating Supplies 1.00 128.24 128.24 CUFF B/P DINAMAP SM ADULT 11 99070 10/01/2013 Onsite Operating Supplies 1.00 34.85 34.85 FOLDER FILE HANGING BLU 12 99070 10/01/2013 Onsite Operating Supplies 1.00 34.85 34.85 FOLDER FILE HANGING BLU 12 99070 10/01/2013 Onsite Operating Supplies 1.00 33.48 33.48 CONT SHARPS CLR HORIZ 5QT/10 99070 10/01/2013 Onsite Operating Supplies 1.00 21.12 21.12 BANDAGE PATCH FABRIC LF 2X3IN/4 99070 10/01/2013 Onsite Operating Supplies 1.00 10.39 10.39 COVER THERM PROBE SURE TEMP 12 99070 10/01/2013 Onsite Operating Supplies 1.00 36.34 36.34 File Folder/2 99070 10/01/2013 Onsite Operating Supplies 1.00 34.85 34.85 FOLDER FILE HANGIAIG BL U12 99070 10/01/2013 Onsite Operating Supplies 1.00 34.85 34.85 FOLDER FILE HANGING BL U12 Invoice# 732112 (continued)page 4 Proc Code Service Date Description Quantity Charge Recei t Adjust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 9.66 9.66 BINDER 3 RING 31N BLU/1 99070 10/01/2013 Onsite Operating Supplies 1.00 24.67 24.67 BINDER 3 RING 31N BLK/I 99070 10/01/2013 Onsite Operating Supplies 1.00 34.85 34.85 FOLDER FILE HANGING BLU 12 99070 10/01/2013 Onsite Operating Supplies 1.00 12.43 12.43 CLEANER COFFEE POT 11 99070 10/01/2013 Onsite Operating Supplies 1.00 1.98 1.98 CONNECTOR MALE:FErt'IALE/I 99070 10/01/2013 Onsite Operating Supplies 1.00 12.30 12.30 SOAP DIAL LIQUID GA/1 99070 10/01/2013 Onsite Operating Supplies 1.00 41.47 41.47 GLOVE A'ITRILE PF LF SM PUR16 99070 10/01/2013 Onsite Operating Supplies 1.00 199.20 199.20 SET BLOOD COLLECT 23G 314 121N14 99070 10/01/2013 Onsite Operating Supplies 1.00 124.43 124.43 CHILD BP CUFFS,ASST/1 99070 10/01/2013 Onsite Operating Supplies 1.00 486.28 486.28 vaccine fridge/I 99070 10/01/2013 Onsite Operating Supplies 1.00 18.95 18.95 Connector male:male/1 99070 10/01/2013 Onsite Operating Supplies 1.00 49.30 49.30 UTENSIL 6VRAP KNIFE FORK SPOON/1 99070 10/01/2013 Onsite Operating Supplies 1.00 26.27 26.27 STAMP CUSTOM 11 99070 10/01/2013 Onsite Operating Supplies 1.00 6.61 6.61 INK REFILL BLK IDEAL STAMP/I 99070 10/01/2013 Onsite Operating Supplies 1.00 4.74 4.74 KIT SUTR REMOVAL ST 16 99070 10/01/2013 Onsite Operating Supplies 1.00 15.55 15.55 141ASHER ELEPHANT EAR TIP/I 99070 10/01/2013 Onsite Operating Supplies 1.00 4.99 4.99 14"A TER BOTTLED 20OZ CA 124 EA/1 99070 10/01/2013 Onsite Operating Supplies 1.00 18.50 18.50 SENSOR ULTRA BURDICK E35012 99070 10/01/2013 Onsite Operating Supplies 1.00 11.98 11.98 SYR 20CC W/O NDL/I 99070 10/01/2013 Onsite Operating Supplies 1.00 6.84 6.84 ENV CLASP BRN 9X12/I 99070 10/01/2013 Onsite Operating Supplies 1.00 7.82 7.82 ENV CLASP 6X911 99070 10/01/2013 Onsite Operating Supplies 1.00 232.14 232.14 TANK EBT/RBT 108 LITER/1 99070 10/01/2013 Onsite Operating Supplies 1.00 267.58 267.58 PRESCRIPTION PRINTER TONER/I 99070 10/01/2013 Onsite Operating Supplies 1.00 6.47 6.47 ENV NO 10 PLAIN/1 Invoice# 7321 12(continued)page 5 Proc Code Service Date Description Quantity Charge Receipt Adiust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 6.67 6.67 CONT SHARPS CLR HORIZ 5QT/I 99070 10/01/2013 Onsite Operating Supplies 1.00 5.84 5.84 APPLICATOR OB/GYN PLASTIC 81N// 99070 10/01/2013 Onsite Operating Supplies 1.00 21.68 21.68 L UBRICANT SURGIL UB 3GM FOIL PK/I 99070 10/01/2013 Onsite Operating Supplies 1.00 39.98 39.98 SCALPEL SAFETY DISPOSAL NO I]// 99070 10/01/2013 Onsite Operating Supplies 1.00 65.99 65.99 BOA'SUGGESTION 147/CARDS/1 99070 10/01/2013 Onsite Operating Supplies 1.00 36.00 36.00 EBT YEL TAPE STRIPS 500 1PKG/I 99070 10/01/2013 Onsite Operating Supplies 1.00 21.00 21.00 TABLET BL UING NO 100/1 99070 10/01/2013 Onsite Operating Supplies 1.00 289.14 289.14 Intoximeter Calibration Tanl✓1 99070 10/01/2013 Onsite Operating Supplies 1.00 32.02 32.02 STAMP CUSTOM11 99070 10/01/2013 Onsite Operating Supplies 1.00 18.19 18.19 GLOVE EXAM ALOETOUCH PF MED/4 99070 10/01/2013 Onsite Operating Supplies 1.00 9.61 9.61 PAD EYE ST 1518 X 2 5 181AI// 99070 10/01/2013 Onsite Operating Supplies 1.00 7.25 7.25 ALCOHOL ISOPROPYL RUB 70% 16OZ14 99070 10/01/2013 Onsite Operating Supplies 1.00 9.97 9.97 PILLOW REUSABLE STD MV25IN/l 99070 10/01/2013 Onsite Operating Supplies 1.00 7.34 7.34 CLEANSER SKIN SEA-CLENS 2041,11 99070 10/01/2013 Onsite Operating Supplies 1.00 6.07 6.07 SYR 3A4L 23GA IIN NDL DISP/I 99070 10/01/2013 Onsite Operating Supplies 1.00 3.92 3.92 NDL HYPO 23GA/IIN/I 99070 10/01/2013 Onsite Operating Supplies 1.00 12.05 12.05 SOAP DIAL FOAM PUMP 7.5OZ 14 99070 10/01/2013 Onsite Operating Supplies 1.00 28.13 28.13 GLOVE PF LF CRITERION LG 14 99070 10/01/2013 Onsite Operating Supplies 1.00 10.63 10.63 BAAIDAGE ELASTIC 41N VELCRO/l 99070 10/01/2013 Onsite Operating Supplies 1.00 331.87 331.87 toner/2 99070 10/01/2013 Onsite Operating Supplies 1.00 6.82 6.82 PAD ALCOHOL.PREP NS MED/4 99070 10/01/2013 Onsite Operating Supplies 1.00 86.54 86.54 FOAMALCOHOL ALCARE 9OZ112 99070 10/01/2013 Onsite Operating Supplies 1.00 12.96 12.96 air way oral/1 99070 10/01/2013 Onsite Operating Supplies 1.00 4.38 4.38 TAPE SURGICAL MICROPORE I IN/l Invoice# 7321 12 (continued)page 6 Proc Code Service Date Description Quantit Charge Receipt Adjust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 10.86 10.86 BANDAGE ELASTIC VELCRO 31N 11 99070 10/01/2013 Onsite Operating Supplies 1.00 5.47 5.47 STD 141EIGHT SHEET PROT IOOPK/I 99070 10/01/2013 Onsite Operating Supplies 1.00 10.86 10.86 BANDAGE ELASTIC VELCRO 31N/I 99070 10/01/2013 Onsite Operating Supplies 1.00 36.00 36.00 EBT)'EL TAPE STRIPS 500 1PKG/I 99070 10/01/2013 Onsite Operating Supplies 1.00 19.87 19.87 TISSUE/6 99070 10/01/2013 Onsite Operating Supplies 1.00 3.96 3.96 STRAIGHT SCISSORS BLACK/3 99070 10/01/2013 Onsite Operating Supplies 1.00 34.92 34.92 INDEX CARD 4X6 BLNK 141HT 50OCT/6 99070 10/01/2013 Onsite Operating Supplies 1.00 226.61 226.61 CATHETER/I 99070 10/01/2013 Onsite Operating Supplies 1.00 32.53 32.53 CULTRETTES/I 99070 10/01/2013 Onsite Operating Supplies 1.00 272.92 272.92 HISTOFREEZER/I 99070 10/01/2013 Onsite Operating Supplies 1.00 41.33 41.33 IV Set/I4 99070 10/01/2013 Onsite Operating Supplies 1.00 21.46 21.46 SODIUM CHLORIDE 99070 10/01/2013 Onsite Operating Supplies 1.00 21.13 21.13 BOISE SPLOX 8.5X11,928, FSC/I 99070 10/01/2013 Onsite Operating Supplies 1.00 33.02 33.02 4-TRA)'HORIZONTAL-BLACK/I 99070 10/01/2013 Onsite Operating Supplies 1.00 5.51 5.51 DSG ADHESIVE ISLAND 2X3.5IN LF/I 99070 10/01/2013 Onsite Operating Supplies 1.00 25.38 25.38 SOAP FOAM ALCOHOL ALCARE 7OZ15 99070 10/01/2013 Onsite Operating Supplies 1.00 8.75 8.75 TAPE EXECULABEL D)'A/O/I 99070 10/01/2013 Onsite Operating Supplies 1.00 112.33 112.33 GLOVE SURG ESTEEM LF 7.0/1 99070 10/01/2013 Onsite Operating Supplies 1.00 53.96 53.96 GLOVE SURG PF S)'NTH LF 7.511 99070 10/01/2013 Onsite Operating Supplies 1.00 19.80 19.80 pediatric mask-nebulizer/IO 99070 10/01/2013 Onsite Operating Supplies 1.00 21.58 21.58 electrodes/2 99070 10/01/2013 Onsite Operating Supplies 1.00 34.43 34.43 nebulizer/1 99070 10/01/2013 Onsite Operating Supplies 1.00 10.32 10.32 KIT NEB T-MTHPC TBG ADLT 110 99070 10/01/2013 Onsite Operating Supplies 1.00 19.84 19.84 BANDAGE ACEI,V/CLIPS 3IN/I Invoice# 732112 (continued)page 7 Proc Code Service Date Description Quantit Charge Recei t Adiust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 33.02 33.02 4-TRAY HORIZONTAL-BLACK/I 99070 10/01/2013 Onsite Operating Supplies 1.00 48.97 48.97 TOILET PAPER/1 99070 10/01/2013 Onsite Operating Supplies 1.00 59.65 59.65 wall foam bracket/I 99070 10/01/2013 Onsite Operating Supplies 1.00 21.13 21.13 BOISE SPLOX 8.5 1 1,928, FSC/I 99070 10/01/2013 Onsite Operating Supplies 1.00 6.71 6.71 INDEX A4AKER 12TB WHITE 1 PK /I 99070 10/01/2013 Onsite Operating Supplies 1.00 0.80 0.80 MESH JUMBO PENCIL CUP BLACK/I 99070 10/01/2013 Onsite Operating Supplies 1.00 1.56 1.56 3X5 BLANK WHT INDEX CRDS 500PK/I 99070 10/01/2013 Onsite Operating Supplies 1.00 124.10 124.10 Height stick/1 99070 10/01/2013 Onsite Operating Supplies 1.00 67.74 67.74 Thigh Cuff/2 99070 10/01/2013 Onsite Operating Supplies 1.00 44.35 44.35 INFANT CUFF/2 99070 10/01/2013 Onsite Operating Supplies 1.00 16.49 16.49 PEDIATRIC EYE CHAR T11 99070 10/01/2013 Onsite Operating Supplies 1.00 27.76 27.76 PEDIATRIC O X IMETER SENSOR// 99070 10/01/2013 Onsite Operating Supplies 1.00 6.47 6.47 ENV 910 WHITE 500 COUNT 11 99070 10/01/2013 Onsite Operating Supplies 1.00 82.58 82.58 SLIDE HEMOCCULT/I 99070 10/01/2013 Onsite Operating Supplies 1.00 21.13 21.13 BOISE SPLO X 8.5X11,928, FSC/I 99070 10/01/2013 Onsite Operating Supplies 1.00 5.33 5.33 SHARPIE Y FINE BLACK 12 PACK11 99070 10/01/2013 Onsite Operating Supplies 1.00 2.30 2.30 RECYCLED CLIPBRD HRDBD-LTR 14 99070 10/01/2013 Onsite Operating Supplies 1.00 27.18 27.18 2.25A'4 CARD FILE BLACK 500CARD/1 99070 10/01/2013 Onsite Operating Supplies 1.00 24.97 24.97 MOUTHPIECE PEAK FLOW DISP ADUL 11 99070 10/01/2013 Onsite Operating Supplies 1.00 34.76 34.76 SPECULUM VAG PEDERSON LG DISP/I 99070 10/01/2013 Onsite Operating Supplies 1.00 2.40 2.40 PAD AjWHONIA INHALANT/1 99070 10/01/2013 Onsite Operating Supplies 1.00 9.82 9.82 PILLOW REUSABLE STD 19X25IN/l 99070 10/01/2013 Onsite Operating Supplies 1.00 15.01 15.01 NAPE GERMICIDAL SANI-CLOTH LG 13 99070 10/01/2013 Onsite Operating Supplies 1.00 7.30 7.30 wound closure tray/1 Invoice# 732112 (continued)page 8 Proc Code Service Date Description Quantity Charge Recei t Adjust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 26.96 26.96 TOWEL POLYGRN/1 99070 10/01/2013 Onsite Operating Supplies 1.00 35.81 35.81 SPECULUA/VAG DISP MED/1 99070 10/01/2013 Onsite Operating Supplies 1.00 35.81 35.81 SPECULUM VAG DISP SM N1 1BAR11 99070 10/01/2013 Onsite Operating Supplies 1.00 19.34 19.34 METER PEAK FLO14'FULL 50-890/l 99070 10/01/2013 Onsite Operating Supplies 1.00 29.30 29.30 ADHESIVE AIASTISOL LIQUID 2OZ 11 99070 10/01/2013 Onsite Operating Supplies 1.00 12.24 12.24 HAMMER PERCUSSION REFLEX 12 99070 10/01/2013 Onsite Operating Supplies 1.00 51.53 51.53 CUFF BP ADULT LG LF SZ 1212 99070 10/01/2013 Onsite Operating Supplies 1.00 220.67 220.67 ILLUMINATOR KLEENSPEC VAGINAL 11 99070 10/01/2013 Onsite Operating Supplies 1.00 548.47 548.47 digital scale/1 99070 10/01/2013 Onsite Operating Supplies 1.00 24.97 24.97 MOUTHPIECE PEAK FLOW PED/I 99070 10/01/2013 Onsite Operating Supplies 1.00 50.83 50.83 blood pressure cuff/2 99070 10/01/2013 Onsite Operating Supplies 1.00 48.00 48.00 FORM PT SIGN IN SHEET PEEL OFF/I 99070 10/01/2013 Onsite Operating Supplies 1.00 28.79 28.79 TOWEL PAPER Z-FOLD/1 99070 10/01/2013 Onsite Operating Supplies 1.00 33.02 33.02 4-T RAY HORIZONTAL-BLACK/I 99070 10/01/2013 Onsite Operating Supplies 1.00 3.34 3.34 CLIP DISP LARGE W 1100 CLIPS I] 99070 10/01/2013 Onsite Operating Supplies 1.00 1.73 1.73 RECYCLED CLIPBRD HRDBD-LTR 13 99070 10/01/2013 Onsite Operating Supplies 1.00 197.74 197.74 THERM ORAL SYSTEM PKG M690 4FT/1 99070 10/01/2013 Onsite Operating Supplies 1.00 130.96 130.96 PEDIATRIC BLOOD PRESSURE CUFF/I 99070 10/01/2013 Onsite Operating Supplies 1.00 94.67 94.67 Chart 1701der/3 99070 10/01/2013 Onsite Operating Supplies 1.00 217.87 217.87 toollied forcep/1 99070 10/01/2013 Onsite Operating Supplies 1.00 304.36 304.36 OPTHALA4OSCOPE HEAD{41A 3.5V 12 99070 10/01/2013 Onsite Operating Supplies 1.00 17.50 17.50 LABEL TAPE DI BLK PRINT/IVHITE 12 99070 10/01/2013 Onsite Operating Supplies 1.00 30.62 30.62 wall enclosure system 13 99070 10/01/2013 Onsite Operating Supplies 1.00 566.65 566.65 airlift adjustable stool w/bac 13 Invoice# 732112(continued)page 9 Proc Code Service Date Description Quantity Charge Recei t Adjust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 6.90 6.90 sharp container 13 99070 10/01/2013 Onsite Operating Supplies 1.00 28.31 28.31 114 POLE/1 99070 10/01/2013 Onsite Operating Supplies 1.00 61.73 61.73 dymo label manager 11 99070 10/01/2013 Onsite Operating Supplies 1.00 77.88 77.88 Aledium basket/10 99070 10/01/2013 Onsite Operating Supplies 1.00 77.88 77.88 Aledium basket/10 99070 10/01/2013 Onsite Operating Supplies 1.00 66.24 66.24 small basket/10 99070 10/01/2013 Onsite Operating Supplies 1.00 70.54 70.54 LABEL CERNER COATED THERMAL/1 99070 10/01/2013 Onsite Operating Supplies 1.00 145.85 145.85 PULSE OX 99070 10/01/2013 Onsite Operating Supplies 1.00 9.71 9.71 basic spill ki112 99070 10/01/2013 Onsite Operating Supplies 1.00 48.88 48.88 large adult c7 ff/1 99070 10/01/2013 Onsite Operating Supplies 1.00 40.25 40.25 reusable cuff/I 99070 10/01/2013 Onsite Operating Supplies 1.00 35.88 35.88 SUNDRYJAR/1 99070 10/01/2013 Onsite Operating Supplies 1.00 2.22 2.22 forcep/1 99070 10/01/2013 Onsite Operating Supplies 1.00 5.87 5.87 wal ter forcep/1 99070 10/01/2013 Onsite Operating Supplies 1.00 3.40 3.40 BUPIVACAINE INJ.5%50IL/I 99070 10/01/2013 Onsite Operating Supplies 1.00 464.16 464.16 OTSCP DIGC MACROVIEW 3.5V FXD 13 99070 10/01/2013 Onsite Operating Supplies 1.00 10.07 10.07 COVER THERM/PROBE SURE TEMP 12 99070 10/01/2013 Onsite Operating Supplies 1.00 49.48 49.48 SET BLOOD COLLECT 23G 314 12in/1 99070 10/01/2013 Onsite Operating Supplies 1.00 151.93 151.93 OPTHALAIOSCOPE HEAD IVA 3.51411 99070 10/01/2013 Onsite Operating Supplies 1.00 937.99 937.99 CHRGR DSK CMPCT PORT UN CNV/3 99070 10/01/2013 Onsite Operating Supplies 1.00 27.01 27.01 CA UT DXSTK BTRY OPTH HI TEMP 13 99070 10/01/2013 Onsite Operating Supplies 1.00 5.74 5.74 CONTROL NORMAL 2.5ilIL/I 99070 10/01/2013 Onsite Operating Supplies 1.00 26.64 26.64 TEST STRIP GL UCOSE 11 99070 10/01/2013 Onsite Operating Supplies 1.00 8.51 8.51 Z-GRIP RET PEN BLACK 24PKII Invoice# 732112 (continued)page 10 Proc Code Service Date Description Quantity Charge Receipt Adjust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 246.72 246.72 DERALIABOND/I 99070 10/01/2013 Onsite Operating Supplies 1.00 52.90 52.90 SUTR PROLENE 4-0 8699G/I 99070 10/01/2013 Onsite Operating Supplies 1.00 41.95 41.95 SUTR ETHILON 5-0 P-3 698G BLK/I 99070 10/01/2013 Onsite Operating Supplies 1.00 0.77 0.77 rL1ESH BUSINESS CARD HOLDER BLK/2 99070 10/01/2013 Onsite Operating Supplies 1.00 18.18 18.18 COMFORT HANDLE 2-HOLE PUNCH/I 99070 10/01/2013 Onsite Operating Supplies 1.00 0.92 0.92 STANDARD ST4PLES-3PK /I 99070 10/01/2013 Onsite Operating Supplies 1.00 6.66 6.66 STETHOSCOPE NURSE LF BLUE 221N/I 99070 10/01/2013 Onsite Operating Supplies 1.00 1.88 1.88 OINTMENT TRIPLE ANTIBIOTIC IOZ/1 99070 10/01/2013 Onsite Operating Supplies 1.00 16.90 16.90 DSG ADAPTIC NON-ADHER 3X31N ST/I 99070 10/01/2013 Onsite Operating Supplies 1.00 0.98 0.98 CUP MEDICINE POL I PRO IOZ/I 99070 10/01/2013 Onsite Operating Supplies 1.00 7.40 7.40 HOLDER VACUTALVR TUBE SNGL USE/I 99070 10/01/2013 Onsite Operating Supplies 1.00 ' 17.93 17.93 TIMER DIGITAL 11 99070 10/01/2013 Onsite Operating Supplies 1.00 37.79 37.79 sladiomeler 11 99070 10/01/2013 Onsite Operating Supplies 1.00 6.13 6.13 SOAP LOTION LOBANA 160Z11 99070 10/01/2013 Onsite Operating Supplies 1.00 0.37 0.37 CANNULA NASAL/I 99070 10/01/2013 Onsite Operating Supplies 1.00 2.23 2.23 CONT SPECIMEN NS 4 OZ/I 99070 10/01/2013 Onsite Operating Supplies 1.00 5.09 5.09 COVER THERM PROBE SURE TEA1P/I 99070 10/01/2013 Onsite Operating Supplies 1.00 8.35 8.35 SYR I ML 27G X.5 INII 99070 10/01/2013 Onsite Operating Supplies 1.00 14.38 14.38 IBUPROFEN TAB 200XIG 250X2/1 99070 10/01/2013 Onsite Operating Supplies 1.00 2.05 2.05 KIT SUTR REMOVAL 141/SCISSORS/1 99070 10/01/2013 Onsite Operating Supplies 1.00 34.87 34.87 DSG CLOSURE SKIN.25 Y3 IN/I 99070 10/01/2013 Onsite Operating Supplies 1.00 12.89 12.89 V1REX 11 320Z/I 99070 10/01/2013 Onsite Operating Supplies 1.00 47.57 47.57 LABEL ALLERGI%1 99070 10/01/2013 Onsite Operating Supplies 1.00 1.80 1.80 DISPENSER TAPE BLACK 0.75IN/I Invoice# 732112(continued)page 11 ♦ s._. ._�-� ���_._ _..., Proc Code Service Date Description Quantit Charge Recei t Adjust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 1.32 1.32 SCISSOR 81N STRAIGHT/I 99070 10/01/2013 Onsite Operating Supplies 1.00 303.84 303.84 EPINEPH INJ 0.3MG SYRINGE-A UT011 99070 10/01/2013 Onsite Operating Supplies 1.00 17.40 17.40 FLUOR-I-STRIP/I 99070 10/01/2013 Onsite Operating Supplies 1.00 7.55 7.55 THERMOMETER REFRIG/FRZR /1 99070 10/01/2013 Onsite Operating Supplies 1.00 5.95 5.95 NDL HYPO 25GA/1.51N /1 99070 10/01/2013 Onsite Operating Supplies 1.00 8.20 8.20 bacolracom Zinc ointment/l 99070 10/01/2013 Onsite Operating Supplies 1.00 80.45 80.45 CURETTE EAR LIGHTED 11 99070 10/01/2013 Onsite Operating Supplies 1.00 5.51 5.51 MASK FACE EARLOOP BLU/1 99070 10/01/2013 Onsite Operating Supplies IM 5.71 5.71 SCALPEL DISP ST NO 15/1 99070 10/01/2013 Onsite Operating Supplies 1.00 15.36 15.36 TEST PREG I STEP+HCG/1 99070 10/01/2013 Onsite Operating Supplies 1.00 5.94 5.94 S141ABSTICK PREP PVP IODINE SGL/1 99070 10/01/2013 Onsite Operating Supplies 1.00 2.40 2.40 PAD AMA/ONIA INHALANT/1 99070 10/01/2013 Onsite Operating Supplies 1.00 35.62 35.62 TEST STREP A/1 99070 10/01/2013 Onsite Operating Supplies 1.00 8.33 8.33 JELL Y L UBRICATING KY 40Z12 99070 10/01/2013 Onsite Operating Supplies 1.00 3.34 3.34 PAD ALCOHOL PREP NS MED 12 99070 10/01/2013 Onsite Operating Supplies 1.00 1.75 1.75 CONT SHARP A GA TOR 1 GA/I 99070 10/01/2013 Onsite Operating Supplies 1.00 4.15 4.15 APPLICATOR COTTON TIP WOOD ST/I 99070 10/01/2013 Onsite Operating Supplies 1.00 6.48 6.48 PACK COLD INSTANT 6X10IN/12 99070 10/01/2013 Onsite Operating Supplies 1.00 1.57 1.57 RAZOR SGL EDGE NS DISP/1 99070 10/01/2013 Onsite Operating Supplies 1.00, 36.22 36.22 SCISSOR LISTER BANDAGE 5.51N/3 99070 10/01/2013 Onsite Operating Supplies 1.00 9.98 9.98 611IPE GERMICIDAL SANI-CLOTH LG/2 99070 10/01/2013 Onsite Operating Supplies 1.00 5.47 5.47 DSG SPONGE GA UZE ST 12PL Y 2X2/1 99070 10/01/2013 Onsite Operating Supplies 1.00 8.81 8.81 SNTZR HAND ALOE GEL 180Z11 99070 10/01/2013 Onsite Operating Supplies 1.00 3.52 3.52 DSG 6VATER JEL BURN/1 Invoice# 732112 (continued)page 12 Proc Code Service Date Description Quantit Charge Receipt Adjust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 1.38 1.38 SOLN IRRIG EYE I OZ/I 99070 10/01/2013 Onsite Operating Supplies 1.00 25.99 25.99 WASH EYE A4ORGAA'1I 99070 10/01/2013 Onsite Operating Supplies 1.00 24.17 24.17 PILLOIVCASE DISP POLYLINE 21X3011 99070 10/01/2013 Onsite Operating Supplies 1.00 7.33 7.33 TOURNIQUET NON-LATEX/I 99070 10/01/2013 Onsite Operating Supplies 1.00 14.18 14.18 SOAP FOAM ALCOHOL ALCARE 7OZ /I 99070 10/01/2013 Onsite Operating Supplies 1.00 3.37 3.37 SLING ARM STD BL XLG/I 99070 10/01/2013 Onsite Operating Supplies 1.00 3.37 3.37 SLING ARM STD BL LG/I 99070 10/01/2013 Onsite Operating Supplies 1.00 3.37 3.37 SLING ARM POCKET DEEP SM/I 99070 10/01/2013 Onsite Operating Supplies 1.00 3.24 3.24 TISSUE FACIAL 2 PLY FLAT/S 99070 10/01/2013 Onsite Operating Supplies 1.00 5.84 5.84 CALADRYL CLEAR LOTAI 6 OZ/I 99070 10/01/2013 Onsite Operating Supplies 1.00 44.08 44.08 TEST REAGENT CHEMSTRIP 10 I'V/SG/I 99070 10/01/2013 Onsite Operating Supplies 1.00 35.93 35.93 LANCET SAFE-T-PRO/I 99070 10/01/2013 Onsite Operating Supplies 1.00 2.69 2.69 SOLN IRRIG NA CL 0.9%500ML 12 99070 10/01/2013 Onsite Operating Supplies 1.00 5.08 5.08 UNDERPAD SURECARE 17X241A11I 99070 10/01/2013 Onsite Operating Supplies 1.00 20.20 20.20 GOJfN EXAM DISP BLU REG ADULT 11 99070 10/01/2013 Onsite Operating Supplies 1.00 5.82 5.82 DEPRF_SSOR TONGUE_NS 61N// 99070 10/01/2013 Onsite Operating Supplies 1.00 3.43 3.43 TOWELETTE BZK CHLORIDE /1 99070 10/01/2013 Onsite Operating Supplies 1.00 9.78 9.78 PENLIGHT DISP 6V/COBALT FILTER/I 99070 10/01/2013 Onsite Operating Supplies 1.00 20.59 20.59 GLOVE NITRILE PF LF MED PUR 13 99070 10/01/2013 Onsite Operating Supplies 1.00 10.68 10.68 RESUSCITATOR SPUR 01/MASK ADULT 11 99070 10/01/2013 Onsite Operating Supplies 1.00 22.20 22.20 SPECULA OTOSCOPE DISP 4.25AdM 11 99070 10/01/2013 Onsite Operating Supplies 1.00 22.20 22.20 SPECULA OTOSCOPE 2.7550,111 99070 10/01/2013 Onsite Operating Supplies 1.00 3.85 3.85 NDL HYPO 27GA 10.51A'/I 99070 10/01/2013 Onsite Operating Supplies 1.00 8.15 8.15 SYR IOA4L 17//O NDL LL 11 Invoice# 7321 12 (continued)page 13 Proc Code Service Date DescrOtlon Quantit Charge Receipt Adiust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 9.79 9.79 NDL HYPO 20G 1.51AV3 99070 10/01/2013 Onsite Operating Supplies 1.00 2.12 2.12 KITSUTR REMOVAL ST 13 99070 10/01/2013 Onsite Operating Supplies 1.00 7.37 7.37 HYDROCORTISONE CR 1%0.9GA41I 99070 10/01/2013 Onsite Operating Supplies 1.00 14.76 14.76 SOAP DIAL FOAM PUMP 7.50Z 15 99070 10/01/2013 Onsite Operating Supplies 1.00 24.91 24.91 SCALPEL D/SP ST NO 11 /1 99070 10/01/2013 Onsite Operating Supplies 1.00 5.71 5.71 SCALPEL DISP ST NO 11/1 99070 10/01/2013 Onsite Operating Supplies 1.00 2.21 2.21 CLEANSER SKIN SHURCLEArS 20AIL 12 99070 10/01/2013 Onsite Operating Supplies 1.00 1.66 1.66 SOLN HYDRGN PEROXIDE 80Z 13 99070 10/01/2013 Onsite Operating Supplies 1.00 13.73 13.73 GLOVE NITRILE PF LF SA4 PUR12 99070 10/01/2013 Onsite Operating Supplies 1.00 4.51 4.51 GLASSES SAFETY WISIDE SHIELD 12 99070 10/01/2013 Onsite Operating Supplies 1.00 6.11 6.11 HAMMER PERCUSSION REFLEX/I 99070 10/01/2013 Onsite Operating Supplies 1.00 5.04 5.04 PAD EYE OVAL ST/1 99070 10/01/2013 Onsite Operating Supplies 1.00 13.80 13.80 GLOVE PF LF CRITERION LG 12 99070 10/01/2013 Onsite Operating Supplies 1.00 8.57 8.57 TAPE SURGICAL TRANSPORE I/N/1 99070 10/01/2013 Onsite Operating Supplies 1.00 34.40 34.40 DSG CLOSURE SKIN.25X3 IN/I 99070 10/01/2013 Onsite Operating Supplies 1.00 9.70 9.70 CHART E1 E TEST DISTANCE 22X1 1/2 99070 10/01/2013 Onsite Operating Supplies 1.00 8.04 8.04 SET SUTURING ST/1 99070 10/01/2013 Onsite Operating Supplies 1.00 5.36 5.36 CONTROL CONTOUR TS 1860 H//1 99070 10/01/2013 Onsite Operating Supplies 1.00 5.36 5.36 CONTROL CONTOUR TS 1859 LOW /1 99070 10/01/2013 Onsite Operating Supplies 1.00 5.36 5.36 CONTROL CONTOUR TS 1858 NORM/1 99070 10/01/2013 Onsite Operating Supplies 1.00 8.40 8.40 OMA'LEGAL PAD PPR RULED ASSTD/1 99070 10/01/2013 Onsite Operating Supplies 1.00 5.54 5.54 OA4X LEGAL PAD 6VHT 5X8 12PK/1 99070 10/01/2013 Onsite Operating Supplies 1.00 21.13 21.13 BOISE SPLOX8.5X11,926, FSC/l 99070 10/01/2013 Onsite Operating Supplies 1.00 5.18 5.18 POCKET HIGHLIGHTERS ASST 12CT/1 Invoice# 732112 (continued)page 14 Proc Code Service Date Description Quantit Charge Receipt Adiust Balance 99070 10/01/2013 Onsite Operating Supplies 1.00 3.94 3.94 SHARPIE FINE PERiWANENT A4RKR1I 99070 10/01/2013 Onsite Operating Supplies 1.00 1.44 1.44 ROUND STIC PEN MED RED 12PKII 99070 10/01/2013 Onsite Operating Supplies 1.00 8.51 8.51 Z-GRIP RET PEN BLACK 24PK/I 99070 10/01/2013 Onsite Operating Supplies 1.00 3.71 3.71 8-DIGIT MINI HANDHELD CALC 99070 10/01/2013 Onsite Operating Supplies 1.00 10.80 10.80 ECON VIV BINDER 611HITE 114 99070 10/01/2013 Onsite Operating Supplies 1.00 0.77 0.77 BINDER CLIPS AIF_D BLACK 24PK 99070 10/01/2013 Onsite Operating Supplies 1.00 0.53 0.53 BINDER CLIPS SAIALL BLACK 36PK 99070 10/01/2013 Onsite Operating Supplies 1.00 0.55 0.55 BINDER CLIPS MINI BLACK 60PK 99070 10/01/2013 Onsite Operating Supplies 1.00 1.28 1.28 BINDER CLIPS BLK LARGE 12PK 99070 10/01/2013 Onsite Operating Supplies 1.00 1.08 1.08 PPR CLIPS#1 1000PK/I 99070 10/01/2013 Onsite Operating Supplies 1.00 3.07 3.07 PPR CLIPS JUMBO 1000PK/1 99070 10/01/2013 Onsite Operating Supplies 1.00 2.64 2.64 STRAIGHT SCISSORS BLACK 12 99070 10/01/2013 Onsite Operating Supplies 1.00 8.75 8.75 3-HOLE PUNCH 20 SHEET MED DUTY11 99070 10/01/2013 Onsite Operating Supplies 1.00 5.44 5.44 STAPLER FULL STRIP BLACK 13 99070 10/01/2013 Onsite Operating Supplies 1.00 0.54 0.54 STAPLE REMOVER JA6V-STYLE/I 99070 10/01/2013 Onsite Operating Supplies 1.00 1.73 1.73 RECYCLED CLIPBRD HRDBD-LTR/1 99070 10/01/2013 Onsite Operating Supplies 1.00 12.85 12.85 1P HANG1AIG FLDR GRN LTR 20BX/1 99070 10/01/2013 Onsite Operating Supplies 1.00 1.54 1.54 LIQUID PAPER MULTIFLUID/I 99070 10/01/2013 Onsite Operating Supplies 1.00 0.59 0.59 CORRECTION FL UID/1 99070 10/01/2013 Onsite Operating Supplies 1.00 3.60 3.60 TAPE DISPENSER DESKTOP 1 CORE 12 99070 10/01/2013 Onsite Operating Supplies 1.00 1.87 1.87 TRANS. TAPE 314X1296 3PK/I 99070 10/01/2013 Onsite Operating Supplies 1.00 8.32 8.32 OS NOTE 3X3 12PK CAAAR 171 99070 10/01/2013 Onsite Operating Supplies 1.00 8.52 8.52 OS NOTE 1.5X2 12PK PASTEL RCLD/1 99070 10/01/2013 Onsite Operating Supplies 1.00 4.56 4.56 BASIN EAIESIS D1SP AIS 120 Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice November 1, 2013 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Misc.Onsite/Oct. 2013 1 Civic Square Carmel, IN 46032- W�.. Invoice# 732156�� Proc Code Service Date Description Quantit Charge Receipt Adjust Balance 99070 09/08/2013 Young at Heart Clinic Meds 1.00 99.22 99.22 99070 09/22/2013 Young at Heart Clinic Meds 1.00 300.10 300.10 99070 09/30/2013 Young at Heart Clinic Meds 1.00 926.11 926.11 99070 10/01/2013 Onsite Lab Charges 1.00 1.092.20 1092.20 Sept.2013 Labs 99070 10/06/2013 Young at Heart Clinic Meds 1.00 505.33 505.33 99070 10/13/2013 Young at Heart Clinic Meds 1.00 239.33 239.33 CITYCARO Invoice# 732156 Balance Due: 3162.29 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLU INVOICE#ON CHECK A Cut and return with payment----------------------------------------------- Please remit 3,162.29 and Make Check Payable to: ❑ YAM VISA INVOICE# 732156 IU Health Workplace Services, LLC ❑ MASTERCARD 2046 Reliable Pkwy Chicago, IL 60686-0020 ACCOUNT NO CSV E\P Phone: 317-963-1535 CODE DATE SIGNATURE AMOUNT PAID Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice November 1, 2013 Bill to: Barbara Lamb For: City of Carmel -Onsite City of Carmel -Onsite Nurse Time/Oct. 2013 1 Civic Square Carmel, IN 46032- ____.� Invoice# 732030 Proc Code Service Date Description Quantity Charge Receiot Adiust Balance NURSEMA 10/01/2013 M.A.Nurse Time 6.00 168.00 168.00 Mareesa A/artin NURSEMA 10/02/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMA 10/03/2013 M.A.Nurse Time 4.00 112.00 112.00 Jennifer Lawson NURSEMA 10/04/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMA 10/07/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMA 10/08/2013 M.A.Nurse Time 6.00 168.00 168.00 Jennifer Lawson NURSEMA 10/09/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lmvson NURSEMA 10/10/2013 M.A.Nurse Time 4.00 112.00 112.00 Jennifer Lawson NURSEMA 10/11/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMA 10/14/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMA 10/15/2013 M.A.Nurse Time 6.00 168.00 168.00 Jennifer Lawson NURSEMA 10/16/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMA 10/17/2013 M.A.Nurse Time 4.00 112.00 112.00 Jennifer Lawson NURSEMA 10/18/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMA 10/21/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMA 10/22/2013 M.A.Nurse Time 6.00 168.00 168.00 Jennifer Lmvson Invoice# 732030(continued)page 2 Proc Code Service Date Description Quantit Charge Receipt Adjust Balance NURSEMA 10/23/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMA 10/24/2013 M.A.Nurse Time 4.00 112.00 112.00 Jennifer Lawson NURSEMA 10/25/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMA 10/28/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMA 10/29/2013 M.A.Nurse Time 6.00 168.00 168.00 Jennifer Lawson NURSEMA 10/30/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMA 10/31/2013 M.A.Nurse Time 4.00 112.00 112.00 Jennifer Lmvson NURSEMD 10/01/2013 MD Staff Time 6.00 1,050.00 1050.00 Dr. Fagan NURSEMD 10/02/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan NURSEMD 10/03/2013 MD Staff Time 4.00 700.00 700.00 Dr. Fagan NURSEMD 10/04/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan NURSEMD 10/07/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan NURSEMD 10/08/2013 MD Staff Time 6.00 1,050.00 1050.00 Dr. Fagan NURSEMD 10/09/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan NURSEMD 10/10/2013 MD Staff Time 4.00 700.00 700.00 Dr. Fagan NURSEMD 10/11/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan NURSEMD 10/14/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan NURSEMD 10/15/2013 MD Staff Time 6.00 1,050.00 1050.00 Dr. Fagan NURSEMD 10/16/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan NURSEMD 10/17/2013 MD Staff Time 4.00 700.00 700.00 Dr. Fagan NURSEMD 10/18/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan NURSEMD 10/21/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan NURSEMD 10/22/2013 MD Staff Time 6.00 1,050.00 1050.00 Dr. Fagan NURSEMD 10/23/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan Invoice# 732030(continued)page 3 Proc Code Service Date Description Quantit Charge Receipt Adiust Balance NURSEMD 10/24/2013 MD Staff Time 4.00 700.00 700.00 Dr. Fagan NURSEMD 10/25/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan NURSEMD 10/28/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan NURSEMD 10/29/2013 MD Staff Time 6.00 1,050.00 1050.00 Dr. Fagan NURSEMD 10/30/2013 MD Staff Time 5.00 875.00 875.00 Dr. Fagan NURSEMD 10/31/2013 MD Staff'fime 4.00 700.00 700.00 Dr. Fagan NURSERN 10/01/2013 R.N.Nurse Time 6.00 372.00 372.00 Given Kopeckv NURSERN 10/02/2013 R.N.Nurse Time 5.00 310.00 310.00 Given Kopecky NURSERN 10/03/2013 R.N.Nurse Time 4.00 248.00 248.00 Gwen Kopecky NURSERN 10/04/2013 R.N.Nurse Time 5.00 310.00 310.00 Given Kopecky NURSERN 10/07/2013 R.N.Nurse Time 5.00 310.00 310.00 Given Kopecky NURSERN 10/08/2013 R.N.Nurse Time 6.00 372.00 372.00 Gwen Kopeckv NURSERN 10/09/2013 R.N.Nurse Time 5.00 310.00 310.00 Given Kopeckv NURSERN 10/10/2013 R.N.Nurse Time 4.00 248.00 248.00 Given Kopecky NURSERN 10/11/2013 R.N.Nurse Time 5.00 310.00 310.00 Given Kopecky NURSERN 10/14/2013 R.N.Nurse Time 5.00 310.00 310.00 Given Kopecky NURSERN 10/15/2013 R.N.Nurse Time 6.00 372.00 372.00 Given Kopecky NURSERN 10/16/2013 R.N.Nurse Time 5.00 310.00 310.00 Given Kopecky NURSERN 10/17/2013 R.N.Nurse Time 4.00 248.00 248.00 Given Kopecky NURSERN 10/18/2013 R.N.Nurse Time 5.00 310.00 310.00 Gwen Kopecky NURSERN 10/21/2013 R.N.Nurse Time 5.00 310.00 310.00 Allartha Rhodes NURSERN 10/25/2013 R.N.Nurse Time 5.00 310.00 310.00 Cassandra Dean NURSERN 10/28/2013 R.N.Nurse Time 5.00 310.00 310.00 Mareesa Marlin NURSERN 10/29/2013 R.N.Nurse Time 6.00 372.00 372.00 A4areesa Harlin Invoice# 732030(continued)page 4 Proc Code Service Date Description Quantity Charge Recei t Adiust Balance NURSERN 10/30/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSERN 10/31/2013 R.N.Nurse Time 4.00 248.00 248.00 Vicki Truitt CITYCARO Invoice# 732030 Balance Due: 2 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE- PLEASE INCLUDE INVOICE#ON CHECK E D Q 0 NOV 4 2013 By Cut and realm with payment Please remit 29,545.00 and Make Check Payable to: ❑ VISA INVOICE# 732030 IU Health Workplace Services, LLC MASTERCARD 2046 Reliable Pkwy Chicago,IL 60686-0020 ACCOUNT NO PSI EXP Phone: 317-963-1535 E DATE SIGNATURE AMOUNT PAS $ 1954S-0 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 I U Health Workplace Services, LLC Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 11 7'11)nCZ7 Onsite Fees (Oet 2013) $4,37 .16 11101113 732156 ite F ------ OnsiteNursingTirne (oct W-f�j 29,545.00 Total $53,297.29 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 N®9/09/13 WARRANT NO. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $ $53,297.29 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 732067 301 14,374.16 materials or services itemized thereon for 732112 301 $16,215.84 which charge is made were ordered and 732156 301 $3,162.29 received except 732030 jnj 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund