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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 • ��, _`'Ir rt d .......... tU} 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