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167103 12/17/2008 CITY OF CARMEL, INDIANA VENDOR: 163730 Page 1 of 1 ONE CIVIC SQUARE INST FOR PUBLIC SAFETY PERSONNEL AMOUNT: $525.00 CARMEL, INDIANA 46032 251 E OHIO STREET SUITE 1000 INDIANAPOLIS IN 46204 CHECK NUMBER: 167103 CHECK DATE: 12/17/2008 DEPARTMENT ACCOUNT PO NUMBE INV OICE NUM AMO UNT DESCRIPTION 1120 4340701 200BRAN28 525.00 MEDICAL EXAM FEES t Ee A -Institute for Public Safety Personnel, Inc. Invoice 251 East Ohio Street, Suite 1000 Indianapolis, IN 46204 DATE INVOICE 12/4/2008 2008ran25 BILL TO Carmel Fire Department 2 Civic Square Carmel, IN 46032 DESCRIPTION i QUANTITY RATE AMOUNT Incumbent fitness for duty psychological 1 525.00 525.00 evaluation for R.K. Make checks payable to: Total $525.00 Insititute for Public Safety Personnel, Inc Phone Fax E -mail 317- 687 -8910 317- 687 -9490 info @ipsp.net 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)) 2008ran25 Fitness for Duty $525.00 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 VOU('HER NO. WARRANT NO. ALLOWED 20 Institute for Public Safety IN SUM OF 251 East Ohio Street, Ste. 1000 Indianapolis, IN 46204 $525.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 2008ran25 43- 407.01 $525.00 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 DEC 15 2008 Title Cost distribution ledger classification if claim paid motor vehicle highway fund