HomeMy WebLinkAbout255207 02/09/16 0i°�4�AM
o`! t�� CITY OF CARMEL, INDIANA VENDOR: 369258
ONE CIVIC SQUARE DLH COUNSELING & CONSULTING CHECK AMOUNT: $*******700.00*
r �' CARMEL, INDIANA 46032 11925 E 65TH ST,SUITE 4 CHECK NUMBER: 255207
, �ror INDIANAPOLIS IN 46236 CHECK DATE: 02/09/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 R4341999 33236 111115.CARME 700.00 PRE EMPL EVALUATION
VOUCHER NO. WARRANT NO.
ALLOWED 20
DLH COUNSELING&CONSULTING
IN SUM OF$
11925 E 65TH ST, SUITE 4
INDIANAPOLIS, IN 46236
$700.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police
cOC-4 Dept. INVOICE NO. ACCT#Fund AMOUNT
Board Members
33236�`"I 111115.carmelpd I 43-419.99 ,I - $700.00 1 hereby certify that the attached invoice(s), Or
1110 Encumbered 101 . .
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
Tuesday, February.02, 2016,
Cost distribution ledger classification if
claim paid motor vehicle highway fund.
DLH Counseling and Consulting,LLC.
Darren L. Higginbotham,Psy.D.
11925 E. 65th Street, Suite 4
Indianapolis, IN 46236
Phone/Fax: (317) 643-9901
dlhcounseling@gmail.com
Tax ID: 45-4501051
Invoice#: 111115.CARMELPD
Re: Two (2) pre-employment psychological evaluations;December 2015
Date of Service: Description of Service: Charge:
December 8, 2015 PERF psychological evaluation (officer) $350.00
December 9, 2015 PERF Psychological evaluation (officer) $350.00
Amount due: $700.00
Please remit payment to the address above. Thank you for your business.
City
®J�° Carmel
INDIANA RETAIL TAX EXEMPT PAGE
111r CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIP;
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 SHIPPING LABELS AND ANY CORRESPONDENCE
JRCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
161-1 counoolft a consulting C@mel ftlico Dopadmont
VENDOR SHIP CIVIC q�ar@
9192-9 E 65th St, Beales 4 TO Calms@l, IN 46032_
Indianapolis, IN 46226- (317)579 2sso
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
2 Each pre-emplcWenl evaluation $ 50.40 $700.00
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Send Invoice To:
Carmel Police Department
Attn: Pat Young
3 Clvlc Squasre
Calnol, Its 46W,-- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECTACCOUNT AMOUNT
Irmel Police Dept. 43.419.9-2 PAYMENT
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND'
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY/HAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. J
THIS APPROP /jTON SUFFICIENT TO PAY FOR THE ABOVE ORDER.
• /f/rf
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY !t'
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 1, hic'?os7 Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 1�q e �; A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE