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227015 12/11/2013 CITY OF CARMEL, INDIANA VENDOR: 367222 Page 1 of 1 ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LL&ECK AMOUNT: $32,191.71 CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHICAGO IL 60686-0020 CHECK NUMBER: 227015 CHECK DATE: 12/11/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 732260 244 . 00 TESTING FEES 301 5023990 732276 24, 699 . 00 OTHER EXPENSES 301 5023990 732397 2, 007 . 00 OTHER EXPENSES 301 5023990 732455 201 . 71 OTHER EXPENSES 1205 4347500 732502 5, 040 . 00 GENERAL INSURANCE Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1535 FEIN: 20-0994452 D DEC 09 2013 Invoice By December 02, 2013 Bill to: Barbara Lamb For: City of Carmel- Onsite City of Carmel-Onsite Onsite/Nov. 2013 1 Civic Square Carmel,IN 46032- Invoice# 732260 Proc Code Date Description 22.00 Invoice# 732260(continued)page 2 80100 11/15/2013 Regulated Drug Screen Due: 244.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Cut and return with payment VOUCHER NO. WARRANT NO. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $244.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 I 732260 I 43-588.00 I $244.00 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, December 09, 2013 Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 12/02/13 732260 Onsite Nov 2013 $244.00 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 Indiana University Health Workplace Services,LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1535 FEIN: 20-0994452 Invoice December 02, 2013 Bill to: Barbara Lamb For: City of Carmel- Onsite City of Carmel-Onsite Misc.Onsite/Nov. 2013 1 Civic Square Carmel,IN 46032- Invoice# 732397 Proc Code Date Description 1y Charae Receipt Adjust Balance 99070 10/20/2013 Young at Heart Clinic Meds 1.00 83.72 83.72 99070 10/27/2013 Young at Heart Clinic Meds 1.00 159.04 159.04 99070 10/31/2013 Young at Heart Clinic Meds 1.00 896.86 896.86 99070 11/01/2013 Onsite Lab Charges 1.00 867.38 867.38 Oct.2013 Labs Balance Due: 2007.00 Invoice# 732397 Balance Due: 2007.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK D b c L 0 9 2013 By �i Cut and return with payment Indiana University Health Workplace Services, LLC 950 North Meridian Street /- Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1535 FEIN: 20-0994452 Invoice December 02, 2013 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Supply Billing/Nov. 2013 1 Civic Square Carmel,IN 46032- Invoice# 732455 Proc Code Date Description -QIC Charge Receipt Adiust Balance 99070 11/01/2013 Onsite Operating Supplies 1.00 24.00 24.00 Shredding 99070 11/01/2013 Onsite Operating Supplies 1.00 27.18 27.18 2.25x4 Card File Black/1 99070 11/01/2013 Onsite Operating Supplies 1.00 2.30 2.30 Recycled Clipboard Hrdbd-Ltr/4 99070 11/01/2013 Onsite Operating Supplies 1.00 21.13 21.13 Boise Splox 8.5x11,92B,FSC/1 99070 11/01/2013 Onsite Operating Supplies 1.00 26.15 26.15 Coffee Folgers Reg 0.9oz/1 99070 11/01/2013 Onsite Operating Supplies 1.00 14.59 14.59 Gel Pen Retr Rbrzd Blue 12p/1 99070 11/01/2013 Onsite Operating Supplies 1.00 25.81 25.81 Pen Gel RT Velocity BlacU3 99070 11/01/2013 Onsite Operating Supplies 1.00 20.59 20.59 Syr tb 27gx0.51 in 12 99070 11/01/2013 Onsite Operating Supplies 1.00 39.96 39.96 Tuberculn PPD IJ 57V lml/1 Balance Due: 201.71 Invoice# 732455 Balance Due: 201.71 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Cut and return with payment - --------------------------------------------------------------------------------- ------ Indiana University Health Workplace Services,LLC 950 North Meridian Street Suite 200 (City of Carmel) � l Indianapolis, IN 46204 Phone: 317-963-1535 D FEIN: 20-0994452 Del: 0 9 2013 Invoice By December 02, 2013 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Cannel-Onsite Nurse Time/Nov. 2013 1 Civic Square Carmel,IN 46032- Invoice# 732276 Proc Code Date Descri tp ion CSC Charce Reeeiot Adiust Balance NURSEMA 11/01/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 11/01/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 11/01/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 11/04/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 11/04/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 11/04/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 11/05/2013 M.A.Nurse Time 6.00 168.00 168.00 Jennifer Lawson NURSEMD 11/05/2013 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 11/05/2013 R.N.Nurse Time 6.00 372.00 372.00 Vicki Truitt NURSEMA 11/06/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 11/06/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 11/06/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 11/07/2013 M.A.Nurse Time 4.00 112.00 112.00 Jennifer Lawson NURSEMD 11/07/2013 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 11/07/2013 R.N.Nurse Time 4.00 248.00 248.00 Vicki Truitt NURSEMA 11/08/2013 M.A.Nurse Time 5.50 154.00 154.00 Jennifer Lawson NURSEMD 11/08/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 11/08/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 11/12/2013 M.A.Nurse Time 6,00 168.00 168.00 Jennifer Lawson Invoice# 732276(continued)page 2 NURSEMD 11/12/2013 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSENP 11/12/2013 N.P.Nurse Time 2.00 190.00 190.00 Johanna Sampson NURSERN 11/12/2013 R.N.Nurse Time 6.00 372.00 372.00 Vicki Truitt NURSEMA 11/13/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 11/13/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSENP 11/13/2013 N.P.Nurse Time 2.00 190.00 190.00 Randi Antworth NURSENP 11/13/2013 N.P.Nurse Time 2.00 190.00 190.00 Johanna Sampson NURSERN 11/13/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 11/14/2013 M.A.Nurse Time 4.00 112.00 112.00 Jennifer Lawson NURSEMD 11/14/2013 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 11/14/2013 R.N.Nurse Time 4.00 248.00 248.00 LoriAnn Horowitz NURSEMA 11/15/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 11/15/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 11/15/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 11/18/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 11/18/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 11/18/2013 R.N.Nurse Time 5.00 310.00 310.00 Dorothy Goen NURSEMA 11/19/2013 M.A.Nurse Time 6.00 168.00 168.00 Jennifer Lawson NURSEMD 11/19/2013 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 11/19/2013 R.N.Nurse"rime 6.00 372.00 372.00 Desire Riedy NURSEMA 11/20/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 11/20/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 11/20/2013 R.N.Nurse Time 5.00 310.00 310.00 Dorothy Goen NURSEMA 11/21/2013 M.A.Nurse Time 4.00 112.00 112.00 Jennifer Lawson NURSEMD 11/21/2013 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 11/21/2013 R.N.Nurse Time 4.00 248.00 248.00 Desire Riedy NURSEMA 11/22/2013 M.A.Nurse Time 5.00 140.00 140.00 Jenn fer Lawson NURSEMD 11/22/2013 MD Staff Time 5.00 875.00 875.00 Dr,Fagan NURSERN 11/22/2013 R.N.Nurse Time 5.00 310.00 310.00 Dorothy Goen Invoice# 732276(continued)page 3 NURSEMA 11/25/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 11/25/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 11/25/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 11/26/2013 M.A.Nurse Time 6.00 168.00 168.00 Jennifer Lawson NURSEMD 11/26/2013 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 11/26/2013 R.N.Nurse Time 6.00 372.00 372.00 Vicki Truitt NURSEMA 11/27/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 11/27/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 11/27/2013 R.N.Nurse Time 5.00 310.00 310.00 Dorothy Goen Balance Due: 24699.00 Invoice# 732276 Balance Due: 24699.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Cut and return with navmP� �� 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)) 12/02/13 739455 Supply Billing (Nov 2013) 201.7 1 12/02/13 732397 Misc Onsite Fees (Nev 2013). 2,001.00 12/02/13 739976 Onsite NuFsing Time (Nov 2013) 24,699.00 Total $26,907.71 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 1\1012iogila WARRANT NO. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $ $26,907.71 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 materials or services itemized thereon for 732455 301 $201.71 which charge is made were ordered and 732397 received except 7-49976 30:1 $94.699 00 20 i nature Cost distribution ledger classification if Title claim paid motor vehicle highway fund �S Indiana University Health Workplace Services, LLC l-� 950 North Meridian Street �z05 Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1535 FEIN: 20-0994452 Invoice Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite EAP Services/2013 I Civic Square Carmel,IN 46032- Invoice# 732502 Proc Code Date Description Qty Charge Receipt Adjust Balance EAPSERV 11/01/2013 EAP Services 1.00 5040.00 5040.00 May-Nov.2013 Balance Due: 5040.00 Invoice# 732502 Balance Due: 5040.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK DEC 0 9 2013 BY Cut and return with payment VOUCHER NO. WARRANT NO. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $5,040.00 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1205 I 732502 I 43-475.00 I $5,040.00 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, December 09, 2013 Director, Administration Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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 732502 EAP Services May-Nov 2013 $5,040.00 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