HomeMy WebLinkAbout240413 12/16/2014 r �F. CITY OF CARMEL, INDIANA VENDOR: 361684
® ONE CIVIC SQUARE PROFESSIONAL PSYCHOLOGICAL SERK AMOUNT: S''""""600.00•
;. � CARMEL, INDIANA 46032 10293 N MERIDIAN ST CHECK NUMBER: 240413
+yiroN SUITE 375 CHECK DATE: 12/16/14
INDIANAPOLIS IN 46290
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4341999 120414-CPD 600.00 OTHER PROFESSIONAL FE
PPS
PsychologicalProfessional
Services
10293 North Meridian Street, Suite 375
Indianapolis, Indiana 46290-0409
PHONE: (317)581-2288
FAX: (317)581-2295
December 4, 2014 Invoice#120414-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: Crystal Hughes
DOB: 03/10/1986
INVOICE
September 5, 2014 Fitness for Duty Evaluation $600.00
Charges Include:
Psychological Testing 150.00
Clinical Interview 150.00
Report Writing 150.00
Consult with 3rd party treatment provider 150.00
and/or review treatment records (if needed)
Post-Evaluation Consultation -0-
Total Amount Due $600.00
Invoice Payable Upon Receipt
VOUCHER NO. WARRANT NO.
ALLOWED 20
Professional Psychological Services
IN SUM OF$
I
10293 North Meridian St, Suite 375
Indianapolis, IN 46290
$600.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 120414-CPD 43-419.99 $600.00 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
which charge is made were ordered and
received except
Friday, December 12, 2014
f
Chief of Police
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))
12/04/14 120414-CPD Fitness for Duty Evaluation $600.00
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