192481 12/07/2010 CITY OF CARMEL, INDIANA VENDOR: 00353243 Page 1 of 1
ONE CIVIC SQUARE MICHAEL A. KAUFMAN MD
CARMEL, INDIANA 46032 5245 NORTH CO. ROAD 600 EAST CHECK AMOUNT: $3,D00.00
BROWNSBURG IN 46112
CHECK NUMBER: 192481
CHECK DATE: 12/7/2010
DEPAR AC PO NUM BER INVOIC NUMB AMOUNT DESCRIPTION
1115 4340400 600.00 CONSULTTNG FEES
1120 4357003 2,400.00 INTERNAL INSTRUCT FEE
Invoice
Appropriation 43- 404.00
P.O. 16551
Date: 11/27/2010 Q4
Name of Company: Michael A. Kaufmann, M.D.
Address Zip: 5245 North Co. Rd. 600 East
Brownsburg, Indiana 46112
Telephone No.: 317 -858 -8471
Fax No.: 317 -858 -8718
Project Name: Communications Medical Direction
Goods /Services Provided:
Prep and Delivery of Educational Topics at CCC
Medical Oversight and Direction
General Training and Education
Communications Meetings
Meetings with CCC Medical. Officer
Date Hrs
October 2010 2hrs
November 2010 2hrs
December 2010 2 hrs
GRAND TOTAL 6 hours
x
Signature
Michael A. Kaufmann, M.D.
Printed Name
EXHIBIT A
MEDICAL DIRECTOR
The Medical Director shall allocate four (4) hours per each three month
quarterly period for the twelve (12) months in the year (16 hours per
year). Allocation of time will be rotated around his hours as an
Emergency Physician. Scheduling for this time will be done through the
Emergency Medical Dispatch (EMD) Coordinator of the Carmel -Clay
Communications Department.
During this time The Medical Director shall perform quarterly audit
and reviews, review 911 EMS calls for service (runs), perform training
and assist with emergency medical dispatch training, and go to meetings
with the EMD Coordinator as requested by the Director of the Carmel
Clay Communications Director.
Compensation will be at $100.00 per hour not to exceed $2,500 per year.
Michael A. Kaufmann, M.D.
5245 North Co. Rd. 600 East
Brownsburg, Indiana .46112
Phone: 317 -858 -8471
Fax: 317- 858 -8718
E -mail: makaufmann(aindj-.rr.com
Ssn: 352 -66 -9697
Medical License 01053866A
A l
VOUCHER NO. WARRANT NO.
ALLOWED 20
Dr. Michael A. Kaufmann
IN SUM OF
5245 No. Co. Road 600 East
Brownsburg, IN 46112
$600.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. I ACCT /TITLE AMOUNT Board Members
1115 I I 43- 404.00 j $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
Wednesday, December 01, 2010
Director
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))
11/27/10 l I I $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
Invoice
Appropriation 4 570 -03
P.O. Box 12455
Date: 11/27/2010
Name of Company: Michael A. Kaufmann, M.D.
Address /Zip: 5245 North CR 600 East
Brownsburg, Indiana 46112
Telephone: 317- 858 -8471
Fa\: 317- 858 -8718
Project Name: EM_S Medical Direction
Services Provided:
Monthly chart review and audit of medical care provided by CFD
Preparation and delivery of CQI report and monthly review
Direct medical oversight /observation of paramedics
General training and education
Administrative meetings as requested
Date Hours
October 8
November 8
December 8
Grand 'Total 24
X
Michael A. Kaufmann, M.D.
VOUCHER NO. WARRANT NO,
ALLOWED 20
Michael Kaufmann, MD
N SUM OF
5245 North Co. Road 600 East
Brownsburg, IN 46112
$2,400.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# 1 Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 43- 570.03 $2,400.00 1 hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
DEC -6 U
a
Fire Chief
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))
$2,400.00
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