242598 02/24/15 C4HI
4 - CITY OF CARMEL, INDIANA VENDOR: 361684
ONE CIVIC SQUARE PROFESSIONAL PSYCHOLOGICAL SER K AMOUNT: $.......600.00'
CARMEL, INDIANA 46032 10293 N MERIDIAN ST CHECK NUMBER: 242598
SUITE 375 CHECK DATE: 02/24/15
INDIANAPOLIS IN 46290
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340703 2182015-CPD 600.00 MENTAL HEALTH COUNSEL
r FC9 2015
ten,
Services
10293 North Meridian Street, Suite 375
Indianapolis, Indiana 46290-0409
PHONE: (317)581-2288
FAX: (317)581-2295
I
February 18, 2015 Invoice #2182015-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: Todd Robbins
INVOICE
February 5, 2015 Pre-evaluation consultation w/ employer No charge
Psychological Testing $150
Clinical Interview $150
Report Writing $150
Consult with 3rd party treatment provider $150
And/or review treatment records
Post-evaluation consultation w/ employer No charge
Total Amount Due $600.00
Invoice Payable Upon Receipt
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))
02/18/15 2182015-CPD Psychological 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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Professional C
5Ici' ,L"��ca .5e,,rvn6j IN SUM OF $
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$600.00 oyzq
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 I 2182015-CPD I 43-407.03 I $600.00 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
Thursday, February 19, 2015
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund