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228050 1 /14/2014 CITY OF CARMEL, INDIANA VENDOR: 367222 Page 1 of 1 f ONE CIVIC SQUARE IU HEALTH WORKPLACE SERVICES LL&ECK AMOUNT: $42,639.05 o CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHICAGO IL 60686-0020 CHECK NUMBER: 228050 CHECK DATE: 1/14/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 5023990 732296 4 , 374 . 16 OTHER EXPENSES 301 5023990 732545 4 , 374 . 16 OTHER EXPENSES 301 5023990 732546 30, 133 . 75 OTHER EXPENSES 1201 4358800 732565 500 . 00 TESTING FEES 1201 4358800 732583 52 . 00 TESTING FEES 301 5023990 732700 1, 957 . 02 OTHER EXPENSES 301 5023990 732720 527 . 96 OTHER EXPENSES 1205 4347500 732751 720 . 00 GENERAL INSURANCE Indiana University Health Workplace Services, LLC 3g 1 950 North Meridian Street Suite 200 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 Onsite Fees/Nov.2013 1 Civic Square Carmel,IN 46032- Invoice# 732296 Proc Code Date Description Qty Charge Receipt Qijust Balance CARMBUIL 11/01/2013 City of Carmel Clinic Build Out 1.00 2574.16 2574.16 CARMLEAS 11/01/2013 City of Carmel Sports Performance 1.00 1800.00 1800.00 Lease Balance Due: 4374.16 Invoice# 732296 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To JAN 2014 Clergy; Treasurer Cut and return with payment Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice January 02, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Cannel- Onsite Misc.Onsite/Dec. 2013 1 Civic Square Cannel,IN 46032- Invoice# 732700 Proc Code Date Descritp ion Qty Charae Receipt Adjust Balance 99070 11/10/2013 Young at Heart Clinic Meds 1.00 23.93 23.93 99070 11/17/2013 Young at Heart Clinic Meds 1.00 653.84 653.84 99070 12/01/2013 Onsite Lab Charges 1.00 652.42 652.42 Nov.2013 SQMF Labs 99070 12/08/2013 Young at Heart Nail-Ins 1.00 30.44 30.44 99070 12/08/2013 Young at Heart Clinic Meds 1.00 218.54 218.54 99070 12/22/2013 Young at Heats Mail-Ins 1.00 377.85 377.85 Balance Due: 1957.02 Invoice# 732700 Balance Due: 1957.02 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submittedo "I"i JAN A12014 Clerk r Cut and return with payment Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice January 02, 2014 Bill to: Barbara Lamb For: City of Carmel- Onsite City of Cannel-Onsite Supply Billing/Dec: 2013 1 Civic Square Carmel,IN 46032- Invoice# 732720 Proc Code lite Description Qty Charge eceip AdjustBalance 99070 12/01/2013 Onsite Operating Supplies 1.00 •1-2:00 12.00 Oxygen/2 99070 12/01/2013 Onsite Operating Supplies 1.00 21.13 21.13 Boise Splor 8.5x I 1,92B,FSC/1 99070 12/01/2013 Onsite Operating Supplies 1.00 27.18 27.18 2.25.0 Card File Black 500card/l " 99070 12/01/2013 Onsite Operating Supplies 1.00 51.52 51.52 Set Blood Collect 23G 3/4 12in/1 99070 12/01/2013 Onsite Operating Supplies 1.00 69.00 69.00 Mouthpiece EBT Fcir Non Trap/200 99070 12/01/2013 Onsite Operating Supplies 1.00 36.74 36.74 Plain non-Laminated Tabs/1 99070 12/01/2013 Onsite Operating Supplies 1.00 10.86 ` 10.86 Cont Sharp A Gator l ga/5 99070 12/01/2013 Onsite Operating Supplies 1.00 8.21 8.21 Pack Cold Instant 6x10 in/15 99070 12/01/2013 Onsite Operating Supplies 1.00 46.26 46.26 Test Mono One Step/1 99070 12/01/2013 Onsite Operating Supplies 1.00 11.36 11.36 Scissor Lister Bandage 5.5in/1 99070 12/01/2013 Onsite Operating Supplies 1.00 0.86 0.86 Soli Hydrgn Peroxide 3%1 99070 12/01/2013 Onsite Operating Supplies 1.00 1.69 1.69 Soln Hvdrgn Peroxide 2oz/1 99070 12/01/2013 Onsite Operating Supplies 1.00 0.56 0.56 Soln Hydrgn Peroxide 8oz/1 99070 12/01/2013 Onsite Operating Supplies 1.00 44.65 44.65 Curette Far Oval Loop Wht/1 99070 12/01/2013 Onsite Operating Supplies 1.00 47.46 47.46 Scope Curette Far/1 99070 12/01/2013 Onsite Operating Supplies 1.00 8.75 8.75 3-Hole Punch 20 Sheet Med Du/1 99070 12/01/2013 Onsite Operating Supplies 1.00 7.16 7.16 Glove Nitrile PF LF Lg Pur/1 99070 12/01/2013 Onsite Operating Supplies 1.00 21.49 21.49 Glome Nitrile PF LF Med Pur/3 99070 12/01/2013 Onsite Operating Supplies 1.00 21.49 21.49 Glove Nitrile PF LF Sm Pur/3 Invoice# 732720(continued)page 2 99070 12/01/2013 Onsite Operating Supplies 1.00 78.02 78.02 Test Strep A Quickrue Dipstick/l 99070 12/01/2013 Onsite Operating Supplies 1.00 1.57 1.57 Remover Splinter Out tin/l Balance Due: 527.96 Invoice# 732720 Balance Due: 527.96 ' MAKE PAYMENT TO THE BELOW ADDRESS WITHIN-30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To JAN A 2014 Clerk Treasurer Cw and rehtm with n—ment Indiana University Health Workplace Services, LLC —3o) 950 North Meridian Street Suite 200 Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice January 02, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite Fees/Dec. 2013 1 Civic Square Carmel,IN 46032- Invoice# 732545 Proc Code Date Description City Charcie Receipt A&-sat Balance CARMBUIL 12/01/2013 City of Cannel Clinic Build Out 1.00 2574.16 2574.16 CARMLEAS 12/01/2013 City of Cannel Sports Performance 1.00 1800.00 1800.00 Lease Balance Due: 4374.16 Invoice# 732545 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To itted To 3 JAN ,-42014 Ci r TreaSurer Cut and return with payment — Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 200 (City of Carmel) �1 Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice January 02, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Cannel-Onsite Nurse Time/Dec. 2013 1 Civic Square Cannel,IN 46032- Invoice# 732546 Proc Code Date Descriptio Qty Charge Receipt AU51 Balance NURSEMA 12/02/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 12/02/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSENP 12/02/2013 N.P.Nurse Time 7.25 688.75 688.75 Erin McMurray NURSERN 12/02/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 12/03/2013 M.A.Nurse Time 6.00 168.00 168.00 Jennifer Lawson NURSEMD 12/03/2013 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSENP 12/03/2013 N.P.Nurse Time 6.00 570.00 570.00 Erin McMurray NURSERN 12/03/2013 R.N.Nurse Time 6.00 372.00 372.00 Vicki Truitt NURSEMA 12/04/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 12/04/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSENP 12/04/2013 N.P.Nurse Time 5.00 475.00 475.00 Erin McMurray NURSERN 12/04/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 12/05/2013 M.A.Nurse Time 4.00 112.00 112.00 Jennifer Lawson NURSEMD 12/05/2013 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSERN 12/05/2013 R.N.Nurse Time 4.00 248.00 248.00 Vicki Truitt NURSEMA 12/06/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 12/06/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/06/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 12/09/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson Invoice# 732546(continued)page 2 NURSEMD 12/09/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/09/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 12/10/2013 M.A.Nurse Time 6.00 168.00 168.00 Jennifer Lawson NURSEMD 12/10/2013 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSENP 12/10/2013 N.P.Nurse Time 2.00 190.00 190.00 Erin McMurray NURSERN 12/10/2013 R.N.Nurse Time 6.00 372.00 372.00 Vicki Truitt NURSEMA 12/11/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 12/11/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/11/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 12/12/2013 M.A.Nurse Time 4.00 112.00 112.00 Jennifer Lawson NURSEMD 12/12/2013 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSENP 12/12/2013 N.P.Nurse Time 4.00 380.00 380.00 Erin MCMurraY NURSERN 12/12/2013 R.N.Nurse Time 4.00 248.00 248.00 Vicki Truitt NURSEMA 12/13/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 12/13/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/13/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 12/16/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 12/16/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSENP 12/16/2013 N.P.Nurse Time 5.00 475.00 475.00 Randi Antworth NURSERN 12/16/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 12/17/2013 M.A.Nurse Time 6.00 168.00 168.00 Jennifer Lawson NURSEMD 12/17/2013 MD Staff Time 6.00 1050.00 1050.00 Dr.Fagan NURSERN 12/17/2013 R.N.Nurse Time 6.00 372.00 372.00 Vicki Truitt NURSEMA 12/18/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 12/18/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/18/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 12/19/2013 M.A.Nurse Time 4.00 112.00 112.00 Jennifer Lawson NURSEMD 12/19/2013 MD Staff Time 4.00 700.00 700.00 Dr.Fagan NURSENP 12/19/2013 N.P.Nurse Time 2.00 190.00 190.00 Erin McMurray Invoice# 732546(continued)page 3 NURSERN 12/19/2013 R.N.Nurse Time 4.00 248.00 248.00 Vicki Truitt NURSEMA 12/20/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 12/20/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/20/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 12/23/2013 M.A.Nurse Time 5.00 140.00 140.00 Jennifer Lawson NURSEMD 12/23/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSERN 12/23/2013 R.N.Nurse Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 12/26/2013 M.A.Nurse Time 4.00 112.00 112.00 Bonita Richardson NURSEMD 12/26/2013 MD Staff Time 4.00 700.00 "' 700.00 Dr.Fagan NURSENP 12/26/2013 N.P.Nurse Time 2.00 190.00 190.00 Erin McMurray NURSERN 12/26/2013 R.N.Nurse Time 4.00 248.00 248.00 Mareesa Martin NURSEMA 12/27/2013 M.A.Nurse Time 5.00 140.00 140.00 Kimberly Pride NURSEMD 12/27/2013 MD Staff Time 5.00 875.00 875.00 Dr,Fagan NURSERN 12/27/2013 R.N.Nurse Time 5.00 310.00 310.00 Mareesa Martin NURSEMA 12/30/2013 M.A.Nurse Time 5.00 140.00" 140.00 Kimberly Pride NURSEMD 12/30/2013 MD Staff Time 5.00 875.00 875.00 Dr.Fagan NURSENP 12/30/2013 N.P.Nurse Time 5.00 475.00 475.00 Randi Antworth NURSERN 12/30/2013 R.N.Nurse Time 5.00 310.00 310.00 Vicki Truitt NURSEMA 12/31/2013 M.A.Nurse Time 6.00 168.00 168.00 Bonita Richardson NURSEMD 12/31/2013 MD Staff Time 6.00 1050:00 1050.00 Dr.Fagan NURSERN 12/31/2013 R.N.Nurse Time 6.00 372.00 372.00 Mareesa Martin Balance Due: 30133.75 Invoice# 732546 Balance Due: 30133.75 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Invoice# 732546(continued)page 4 SSubmItted To r3 - JAN 6'2014 Clergy `treasurer Cut and return wilt, 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 739996, Fees! Nov 2013 4,374. 16 01109114 719700 MiGG Onsitei Dee 20!3 1,957.02 01109114 732720 Supp! Billing/ Dee 2013 b2i.96 01109114 73254S 01102114 73225-465 jurse Time! Dee 2013 30,133.[b Total $41,367.05 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 20Clerk-Treasurer VOUCHER9� WARRANT NO. 12/0 % ALLOWED 20 IUW0alth NAIr)rkDlace Services, LLC IN SUM OF $ 2046 Reliable RkmW �I RnRRa_nngn �11 g2A7 fly. ON ACCOUNT OF APPROPRIATION FOR 301 Me a!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 74.16 which charge is made were ordered and 732700 $:L 957 09 received except 7 732545 301 732546 301 31!7_3375- 20 Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund � Indiana University Health Workplace Services, LLC � 's 950 North Meridian Street 1 Z\ Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice January 02, 2014 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Cannel-Onsite Onsite/Nov. 2013 l Civic Square Cannel,M 46032- Invoice# 732565 Proc Code Date Description Qty Charge Receirt Adjust Balance 11/14/2013 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit 15.00 kit Invoice# 732565 (continued)page 2 15.00 kit 15.00 kit Invoice# 732565 (continued)page 3 DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To JAN '2014 Clerk Treaswer Cut and return with payment _ ------------------------------------ a- _ , S� Indiana University Health Workplace Services, LLC 950 North Meridian Street 1'Z 1 Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice January 02, 2014 Bill to: Barbara Latnb For: City of Cannel-Onsite City of Cannel-Onsite Onsite/Dec.2013 1 Civic Square Cannel,IN 46032- Invoice# 732583 Proc Code Date Descritp ion Cly Charge Receipt Adjust Balance 12/23/2013 Quick Read UDS/6panel includes 1.00 15.00 15.00 kit 22.00 Invoice# 732583 Balance Due: 52.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK FJ 42014 Clergy r-aasur r 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 $552.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 732565 43-588.00 $500.00 I hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the 1201 732583 43-588.00 $52.00 materials or services itemized thereon for which charge is made were ordered and received except Monday, January 13, 2014 L✓ 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)) 01/02/14 732565 Onsite Nov 2013 $500.00 01/02/14 732583 Onsite Dec 2013 $52.00 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 Z1 Indiana University Health Workplace Services, LLC 950 North Meridian Street _.. Suite 200 (City of Carmel) Indianapolis, IN 46204 Phone: 317-963-1534 FEIN: 20-0994452 Invoice January 02, 2014 Bill to: Barbara Lamb For: City of Cannel- Onsite City of Cannel-Onsite EAP Services/Dec. 2013 1 Civic Square Cannel,IN 46032- Invoice# 732751 Proc Code Date Description C r e Receipt Ad'us Balance EAPSERV 12/01/2013 EAP Services 1.00 720.00 720.00 Balance Due: 720.00 Invoice# 732751 Balance Due: 720.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To JAN 6 2014 Clerk Treasurer Cut and return with payment VOUCHER NO. WARRANT NO. IU Health Workplace Services, LLC ALLOWED 20 IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $720.00 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1205 I 732751 I 43-475.00 I $720.00 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, J uary 13, 2014 i 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)) 01/02/14 732751 EAP Services $720.00 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