HomeMy WebLinkAbout233575 06/11/14 CITY OF CARMEL, INDIANA VENDOR: 361684
ONE CIVIC SQUARE PROFESSIONAL PSYCHOLOGICAL SER%4tff K AMOUNT: $*******750.00*
CARMEL, INDIANA 46032 10293 N MERIDIAN ST CHECK NUMBER: 233575
9�,f T011�LA SUITE 375 CHECK DATE: 06/11/14
INDIANAPOLIS IN 46290
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340703 52714-CPD 750.00 MENTAL HEALTH COUNSEL
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PPS
Professional Psychological
Services
10293 North Meridian Street, Suite 375
Indianapolis, Indiana 46290-0409
PHONE: (317)581-2288
FAX: (317)581-2295
May 27, 2014 Invoice#52714-CPD
Carmel Police Department Darren L. Higginbotham, Psy.D.
Attn: Assistant Chief James Barlow Tax ID #35-1995725
3 Civic Square
Carmel, Indiana 46032
RE: Amy Stein
INVOICE
May 15, 2014 Fitness for Duty Evaluation $750.00
Charges Include:
Pre-Evaluation Consultation -0-
Review of Documents 150.00
Psychological Testing 150.00
Clinical Interview 150.00
Report Writing 150.00
Review 3'd Party Health Records 150.00
Post-Evaluation Consultation -0-
Total Amount Due $750.00
Invoice Payable Upon Receipt
VOUCHER NO. WARRANT NO.
Professional Psychological Services ALLOWED 20
IN SUM OF$
10293 North Meridian St, Suite 375
Indianapolis, IN 46290
$750.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#!Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1110 52714-CPD 43-407.03 $750.00 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
Fr' June 06, 2014
l �
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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i
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
I
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
05/27/14 52714-CPD Fitness for Duty Evaluation $750.00
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