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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 jX 4A+1.XG� SDS 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 i 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