158964 04/30/2008 CITY OF CARMEL, INDIANA VENDOR: 00353243 Page 1 of 1
ONE CIVIC SQUARE MICHAEL A. KAUFMAN MD CHECK AMOUNT: $4,000.00
CARMEL, INDIANA 46032 5245 NORTH CO. ROAD 600 EAST
BROWNSBURC IN 46112 CHECK NUMBER: 158964
CHECK DATE: 4/30/2008
DEPARTMENT AC COUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 R4340400 16551 800.00 PROFESSIONAL SERVICES
1120 4357003 11 3,200.00 INTERNAL INSTRUCT FEE
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o,
Invoice
Appropriation 570 -03
P.D. 12455
Date: 4/22/2008
Name of Company Michael A. Kaufmann, M.D.
1
t Address/ Zip: 5245 North Co. Rd. 600 East
Brownsburg, Indiana 46112
y Telephone No.: 317- 858 -8471
Fax No.: 317-858-8718
Project Name: EMS Medical Direction
t Invoice No:
3.
Y Goods /Services Provided:
id
Prep and Delivery of monthly A/R at CFD
Direct Medical Oversight /Observation of Paramedics
General Training and Education, LifeNet Meetings
L Communications Meetings, Review run sheets
n Meetings with EMS Chief, TEMS Meetings
Date Hrs
January 2008 8hrs
February 2008 8hrs
March 2008 8hrs
't April 2008 8hrs
�4
GRA D T ®TA 3 urs
X
Signature
t
Michael A. Kaufmann, M.D.
ry
sT
Printed Name
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Prescribed by State Board of Accounts City Fo m 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))
04/22/08 Medical Director Services $3,200.00
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. WARRA NO.
Michael Kaufmann, MD ALLOWED 20
IN SUM OF
5245 North Co. Road 600 East
Brownsburg, IN 46112
$3,200.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 43- 570.03 $3,200.00 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
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
r Invoice
Appropriation 43- 404.00
w P.O. 16551
i
Date; 4/22/2008
Name of Company: Michael A. Kaufmann, M.D.
Address/ Zip: 5245 North Co. Rd. 600 East
Brownsburg, Indiana 46112
r
Telephone No.: 317- 858 -8471
Fax No.: 317 858 -8718
t
Project Name: Communications Medical Direction
2
Goods /Services Provided:
j
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
January 2008 2hrs
February 2008 2hrs
March 2008 2hrs
April 2008 2hrs
GRANq TOTA hours
X
.ri Signature
Michael A. Kaufmann, M.D.
Printed Name
t
i,:
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. Ind. 600 East
Brownsburg, Indiana 46112
Phone: 317- 858 -8471
Fax: 317 -858 -8718
E -mail: makaufman0dndy.rr.com
Ssn: 352 -66 -9697
Medical License 01053866A
.A
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))
04/22/08 I I I $800.00
1 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 N O.
ALLOWED 20
Dr. Michael A. Kaufmann
IN SUM OF
5245 No. Co. Road 600 East
Brownsburg, IN 46112
$800.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
16551 43- 404.00 $800.00 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
Friday, April 25, 2008
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund