The URL can be used to link to this page

226447 11/19/2013 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1 f ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES 0 CHECK AMOUNT: $8,520.96 CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 +�•�° INDIANAPOLIS IN 46204 CHECK NUMBER: 226447 n c° CHECK DATE: 11/19/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4341999 21600 1, 500 . 00 OTHER PROFESSIONAL FE 1120 4340799 21668 3 , 525 . 00 OTHER MEDICAL FEES 1120 4340799 21718 3 , 135 . 96 OTHER MEDICAL FEES 1110 4341999 21720 360 . 00 OTHER PROFESSIONAL FE INVOICE 0 Public Safety Medical Services r 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Police Department/CARMEPD 3 Civic Square Terms Carmel, IN 46032 Invoice Date 11/13/2013 m Invoice# 00-21720 Date Employee Description Amount Balance Due 11/08/13 Devenport,Adam M. PSY-Specialty Unit Psych Eval $360.00 $360.00 Total Charges-> $360.00 Total Payments&Balance Due-> $0.00 1 $360.00 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 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)) 11/13/13 21720 SWAT eval/ Devenport $360.00 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 Public Safety Medical Services IN SUM OF $ 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $360.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 I 21720 I 43-419.99 I $360.00 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 Friday, November 15, 2013 i 1 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Police Department/CARMEPD ~_ 3 Civic Square Terms Carmel, IN 46032 Invoice Date 10/31/2013 m Invoice# 00-21600 Date Employee Description Amount Balance Due. 10/25/13 Frost Dwight D. PSY-Fit For Duty Psych Eval Initial 750.00 $750.00 Meyer,Ryan J. PSY-Fit For Dut Ps ch Eval Initial 750.00 750.00 Total Charges-> $1,500.00 Total Payments&Balance Due->.. $0.001 $11500:00 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)) 10/31/13 00-21600 fit for duty psych Frost/Meyer $1,500.00 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 Public Safety Medical Services IN SUM OF $ 324 E. New York Street, Suite 300 Indianapolis, IN 46204 $1,500.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 I 00-21600 I 43-419.99 I $1,500.00 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 Thursday, November 14, 2013 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD Attn: Asst Chief David Haboush Terms Invoice Date 11/06/2013 2 Civic Square m Invoice# 00-21668 Carmel, IN 46032 Date Employee Description Amount Balance Due 11/02/13 Allen Brad A. Respirator/Medical Review $25.00 $25.00 Alverson Jonathan L. Respirator/Medical Review $25.00 $25.00 Bailey.Mark E. V11 Respirator/Medical Review $25.00 $25.00 Baskerville.Anthony A. '� Respirator/Medical Review $25.00 $25.0 0 Baskerville.Steven P. Respirator/Medical Review $25.00 $25.00 Benbow.Kip S. ✓ Respirator/Medical Review $25.00 $25.00 Bondurant Jeff S. Res irator/Medical Review $25.00 $25.0 0 Bowles.Orbie H.✓ Respirator/Medical Review $25.00 $25.00 Brandt.Gary D. Respirator/Medical Review $25.00 $25.00 Brant Kenneth E. Res irator/Medical Review $25.00 $25.00 Bri co Michael D.✓ R it for M dic I Review $25.00 $25.0 0 Buttler,James N. ✓ Respirator/Medical Review $25.00 $25.00 Butts Joseph A.✓ Respirator/Medical Review $25.00 $25.00 Butts Renee L. Respirator/Medical Review $25.00 $25.00 Ca shave Jeffrey A. Respirator/Medical Review $25.00 $25.00 Castor. Rick S. ✓ Respirator/Medical Review $25.00 $25.0 0 Collins Tony A. ✓ Respirator/Medical Review $25.00 $25.00 Condra Kyle E. ✓ Respirator/Medical Review $25.00 $25.00 Conner.Timothy L.✓ Respirator/Medical Review $25.00 $25.0 0 Contino. David M.✓ Respirator/Medical Review $25.00 $25.0 0 Cox Jordan R. Respirator/Medical Review $25.00 $25.0 0 Cox Justin M. ✓ Respirator/Medical Review $25.00 $25.00 Crane,Barry ReSDirator/Medical Review $25.00 $25.0 Cromlich,Mark A.&/ Respirator/Medical Review $25.00 $25.00 Cummins Frank C. Respirator/Medical Review $25.00 $25.00 Davis.James M. ✓ Respirator/Medical Review $25.00 $25.00 DeCrastos Richard A. ✓ Respirator/Medical Review $25.00 $25.00 Deitsch.Marc W.✓ Respirator/Medical Review $25.00 $25.0 0 DeLong,Michael T. ' Respirator/Medical Review $25.00 $25.0 0 Dorsch James E. ✓ Respirator/Medical Review $25.00 $25.00 Edwards Daniel E. Respirator/Medical Review $25.00 $25.00 Edwards.Steven L. Respirator/Medical Review $25.00 $25.00 Ellison.Christo her M. Respirator/Medical Review $25.00 $25.0 0 Essex Cory C. ✓ Respirator/Medical Review $25.00 $25.0 0 Fagin,Timothy Resoirator/Medical Review $25.00 $25.00 Fisher,Gary L.✓ Respirator/Medical Review $25.00 $25.00 Freer Keith T.✓ Respirator/Medical Review $25.00 $25.00 Frenzel,Eric C. ✓ Respirator/Medical Review $25.00 $25.00 Frost.Bruce S. Respirator/Medical Review $25.00 $25.0 0 Frye,Steven R. Respirator/Medical Review $25.00 $25.00 Fuchs Jeffery W. Respirator/Medical Review $25.00 $25.00 Gehlbach Marc A. Respirator/Medical Review $25.00 $25.00 Giles.William G.✓ Respirator/Medical Review $25.00 $25.00 Gipson,Bruce E. Respirator/Medical Review $25.00 $25.0 0 Greiner Brandon J. Respirator/Medical Review $25.00 $25.00 Griffin Timothy M. Res irator/Medical Review $25.00 $25.00 INVOICE 0 Public Safety Medical Services w 324 E. New York Street E Suite 300 m a: Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD Attn: Asst Chief David Haboush Terms Invoice Date 11/06/2013 2 Civic Square m Carmel, IN 46032 Invoice# 00-21668 Date Employee Description Amount Balance Due Grimes Jeffrey A. s/ Respirator/Medical Review $25.00 $25.00 Gu el Mark E. Respirator/Medical Review $25.00 $25.00 Haboush David G. Res irator/Medical Review $25.00 $25.0 0 Harrington,A m Q. ✓ irtr eicl Review $25.00 2 Haus,Joshua S. / Respirator/Medical Review $25.00 $25.00 Haymaker,Samuel K. Respirator/Medical Review $25.00 $25.00 Heavner,Joel S. ✓ Respirator/Medical Review $25.00 $25.00 Heinlein.Robert A. Respirator/Medical Review $25.00 $25.00 Hensley,Robert P.✓ Respirator/Medical Review $25.00 $25.0 0 Hoffman.Matthew F.✓ Respirator/Medical Review $25.00 $25.0 0 Holden,Adam D. 7 Respirator/Medical Review $25.00 $25.0 0 Holubik.Steven W./ Respirator/Medical Review $25.00 $25.00 Hoover Anthony B.✓ Res irator/Medical Review $25.00 $25.0 0 Horner David W. Respirator/Medical Review $25.00 $25.0 0 Howard Wendell E.✓ Res irator/Medical Review $25.00 $25.0 0 Hughes,Chad L./ Rewirator/Medical Review $25.00 Hulett Mark A.✓' Respirator/Medical Review $25.00 $25.00 Hutchison Brian R/ Respirator/Medical Review $25.00 $25.00 Johnson Jeremy S. Respirator/Medical Review $25.00 $25.00 Keaton.Anthony R. Respirator/Medical Review $25.00 $25.00 Kelsheimer,TroV We, Respirator/Medical Review $25.00 $25.00 KinneV,Jared N. Respirator/Medical Review $25.00 $25.00 Lenze Theodore A. Respirator/Medical Review $25.00 $25.0 0 Lux.Michael T.✓ Respirator/Medical Review $25.00 $25.0 0 Malicoat Justin R. Respirator/Medical Review $25.00 $25.00 Maners Jeremy B. Respirator/Medical Review $25.00 $25.0 0 Marcum Bradley D. Res irator/Medical Review $25.00 $25.00 Maroon Ernie R. R it t r M i I Review $25-00 125.QQ Marsh Michael A. Respirator/Medical Review $25.00 $25.00 Martin David D. Respirator/Medical Review $25.00 $25.00 Martin Richard A. Respirator/Medical Review $25.00 $25.00 Mason Bryan L. Respirator/Medical Review $25.00 $25.00 McNab.John D. Respirator/Medical Review $25.00 $25.0 0 McNair.Travis L. Respirator/Medical Review $25.00 $25.00 McNeely, Michael W. Respirator/Medical Review $25.00 $25.001 Mead.David L. Respirator/Medical Review $25.00 $25.00 Mead Jr..Donald R. Respirator/Medical Review $25.00 $25.0 0 Medlen Michael J. Res irator/Medical Review $25.00 $25.0 0 Mitchell James C. Respirator/Medical Review $25.00 $25.0 0 Moriarty, o F. Respirator/Medical Review $25.00 $25.0 Mowery,Anthony W. Respirator/Medical Review $25.00 $25.00 Mulford David A. Respirator/Medical Review $25.00 $25.00 Nicley,Wes W. Respirator/Medical Review $25.00 $25.0 0 Osborne Scott K. Respirator/Medical Review $25.00 $25.00 Paddock. Ronald D. Respirator/Medical Review $25.00 $25.0 0 Payne.Thomas C. Respirator/Medical Review $25.00 $25.00 Peterson.Vernon A. Respirator/Medical Review $25.00 $25.001 INVOICE o Public Safety Medical Services 324 E. New York Street E Suite 300 Q tY Indianapolis, IN 46204 G Carmel Fire Department/CARMEFD Attn: Asst Chief David Haboush Terms 2 Civic Square Invoice Date 11/06/2013 m Carmel, IN 46032 Invoice# 00-21668 Date Employee Description Amount Balance Due Phillips,Craig M. Respirator/Medical Review $25.00 $25.0 0 Plumer,Charles J. Respirator/Medical Review $25.00 $25.00 Price Joseph P. Respirator/Medical Review $25.00 $25.0 0 RaV,Lucas M. Respirator/Medical Review $25.00 $25.0 0 Reecer Jason L. Respirator/Medical Review $25.00 $25.00 Reeves Neil P. Respirator/Medical Review $25.00 $25.00 Reeves Stephen J. Respirator/Medical Review $25.00 $25.00 ReDD ert Ian T. Respirator/Medical Review $25.00 $25.00 Reynolds,Shawn J. Res irator/Medical Review $25.00 $25.0 0 Robinson Mark G. Res irator/Medical Review $25.00 $25.0 0 Robinson. Mitchell e it for edi I Review $25.00 Rohr,Christopher M. Respirator/Medical Review $25.00 $25.00 Ryan.Christopher D. Respirator/Medical Review $25.00 $25.00 Schooley Dustin D. Respirator/Medical Review $25.00 $25.00 Sharp,Adam C. Respirator/Medical Review $25.00 $25.0 0 Small.Thomas D. Respirator/Medical Review $25.00 $25.00 Smith Brian E. Respirator/Medical Review $25.00 $25.001 Sombke.Brad D. Respirator/Medical Review $25.00 $25.00 Spelbring,James E. Respirator/Medical Review $25.00 $25.0 0 Starr Greaory A. Respirator/Medical Review $25.00 $25.00 Steele Jeffrey A. Respirator/Medical Review $25.00 $25.0 0 Steury,Kent C. Res irator/Medical Review $25.00 $25.00 Stindle.Kevin P. Resj)iratg[ZMgdical Review $25.00 $25.00 Stroup,Scott A. Respirator/Medical Review $25.00 $25.00 Sutton Sean B. Respirator/Medical Review $25.00 $25.00 Thomas,Nathan C. Respirator/Medical Review $25.00 $25.00 Thompson.James L. Respirator/Medical Review $25.00 $25.0 0 Thordarson Erik M. Respirator/Medical Review $25.00 $25.00 Tierney,Scott A. Respirator/Medical Review $25.00 $25.00 Tone James D. Respirator/Medical Review $25.00 $25.00 Utzia,Chad M. Res irator/Medical Review $25.00 $25.00 Utzi .Todd T. Respirator/Medical Review $25.00 $25.0 0 Vallone Frank Respirator/Medical Review $25.00 $25.0 0 Viehe Richard E. Res irator/Medical Review $25.00 $25.00 Voskuhl Mark J Respirator/Medical vi w $25,00 $25.00 Walker,Christopher E. Respirator/Medical Review $25.00 $25.00 Watts Trent E. Res irator/Medical Review $25.00 $25.00 Weaver Virgil L. Respirator/Medical Review $25.00 $25.00 Webb.Gregory A. Respirator/Medical Review $25.00 $25.00 Weddin ton.Kurt L. Respirator/Medical Review $25.00 $25.0 0 Wendzel Jason D. Respirator/Medical Review $25.00 $25.00 Woodburn.Scott E. Respirator/Medical Review $25.00 $25.0 0 Workman William J. Respirator/Medical Review $25.00 $25.00 W ant Andrew D. Respirator/Medical Review $25.00 $25.001 Youna,Alan R. Res irator/Medical Review $25.00 25.00 Young,Andrew S. Respirator Medical Review 25.00 E25.00 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 ix Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD Attn: Asst Chief David Haboush Terms Invoice Date 11/06/2013 2 Civic Square m Carmel, IN 46032 Invoice# 00-21668 Date I Employee Description Amount Balance Due Young,Kevin M. Res irator/Medical Review $25.00 25.00 Zeller Michael J. Respirator/Medical Review $25.00 $25.001 Total Charges->1 $3,525.00 Total Payments&Balance Due-> $0.00 1 $3,525.00 Please write invoice number on payment check. - Balance due 15 days from invoice Our Federal Employer Identification Number is 35-2079797 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)) 21668 $3,525.00 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 Public Safety Medical Services IN SUM OF $ 324 East New York Street, Ste. 300 Indianapolis, IN 46204 $3,525.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 1120 I 21668 I 43-407.99 I $3,525.00 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 NOV 18 2013 F 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 a) w Indianapolis, IN 46204 o Carmel Fire Department/CARMEFD Attn: Asst Chief David Haboush Terms 2 Civic Square Invoice Date 11/13/2013 m Invoice# 00-21718 Carmel, IN 46032 Date Employee Description Amount Balance Due 11/05/13 Jenkins John W. Chart Review/Completion $85.94 $85.94 Indiana PERF Exam $193.13 $193.13 Drug Screen 9 +Opiates&Ox codone $42.45 $42.4 5 Applicant Blood Panel-PERF $121.84 $121.84 Veni uncture $3.19 3.19 Tonomet Glaucoma Test 38.20 38.20 Urinalysis-Dipstick $3.19 $3.19 EKG W/Inter 21.22 $21.22 Audiometry 14.86 $14.8 6 PFT-Pulmonary Function Test $35.02 $35.0 2 Vision-Color hih r a) $27.59 $27.5 Vision-Acuity $27.59 $27.59 Vital Signs-HT WT BP P R $0.00 $0.00 Chest X-Ray-PA/LAT(Digital) $63.67 $63.67 PSY-Applicant Psych Eval $360.00 $360.00 Reese,Aaron P. Chart Review/Completion $85.94 $85.94 Indiana PERF Exam $19313 $193.13 Drug Screen 9 +Opiates&Ox codone $42.45 $42.45 _....._.__..._.. ... _...._ Applicant Blood Panel-PERF - ...$121-.84..- $121:84 _.. Tb Skin Test. 7.43 iT43 Veni uncture i3.19 $3.19 _ _. .._. _. .. . ._ •Tonomet Glaucoma Test 38.20• -- 38:20 Uri I si -Dipstick -° .1 . 3.19 EKG W/Inter $21-22 $21..22 '°- Audiometry $14.86 $14.86 PFT-Pulmonary Function Test $35.02 $35.02 Vision-Color Ishihara $27.59 $27.59 Vision-Acuity $27.59 $27.59 Vital Signs-HT WT BP P R $0.00 $0.00 Chest X-Ray-PA/LAT(Digital) 63.67 $63.6 7 PSY-Applicant Psych Eva) $360.00 $360.00 11/06/13 Marvel.Thomas L. Chart Review/Completion $85.94 $85.94 Indiana PERF Exam $193.13 $193.13 Drua Screen 9 +Opiates&Ox codone $42.45 $42.4 5 Armlicant lood Panel-PERF $121.84 $121.84 Tb Skin Test $7.43 $7.43 Veni uncture $3.19 $3.19 Tonometr Glaucoma Test $38.20 $38.20 Urinalysis-Dipstick $3.19 $3.19 EKG W/interp $21.22• $21.22 Audiomet 14.86• 14:86 PFT-Pulmonary Function Test 35.02- $ 5.02 Vision-Color Ishihara 27:59- - 27•.59 -Vision-Acuity $27.59•- 27.59 Vital-Si ns=HT WT BP P•R-- $0.00 AM0 I Chest X-Ray-PA/LAT Di ital 63.67 ....$63.6 INVOICE H Public Safety Medical Services 324 E. New York Street E Suite 300 W Indianapolis, IN 46204 C Carmel Fire Department/CARMEFD �- Attn: Asst Chief David Haboush Terms 2 Civic Square Invoice Date 11/13/2013 m Carmel, IN 46032 Invoice# 00-21718 Date Employee Description I Amount Balance Due PSY-Applicant Psych Eval $360.00 $360.00 11/08/13 Jenkins John W. Tb Skin Test 7.43 $7.431 Total Charges >1 $3,135.96 Total Payments&Balance Due-> $0.00 1 $3,135.96 Please write invoice number on payment check. Our Federal Employer Identification Number is 35-2079797 (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)) 21718 $3,135.96 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 $3,135.96 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 1120 I 21718 I 43-407.99 I $3,135.96 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 NOV 18 i2i011 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund