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Home My WebLink About203513 11/09/2011 CITY OF CARMEL, INDIANA VENDOR: 00353243 Page 1 of 1 ONE CIVIC SQUARE MICHAEL A. KAUFMAN MD i 5245 NORTH CO. ROAD 600 EAST CHECK AMOUNT: $4,400.00 CARMEL, INDIANA 46032 BROWNSBURC IN 46112 CHECK NUMBER: 203513 CHECK DATE: 11/9/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1115 4340400 1,200.00 CONSULTING FEES 1120 4357003 3,200.00 INTERNAL INSTRUCT FEE Invoice Appropriation 570 -03 P.O. Box 12455 Date: 10/24/2011 Q3 October Name of Company: Michael A. Kaufmann, M.D. Address /Zip: 5245 North CR 600 East Brownsburg, Indiana 46112 Telephone: 317- 858 -8471 Fax: 317- 858 -8718 Project Name: EMS 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 and CQI meetings as requested by Chief Hulett Date Hours July 8 August 8 September 8 October 8 Grand Total 32 X Michael A. Kaufmann, M.D. 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)) $3,200.00 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 NO. ALLOWED 20 Michael Kaufmann, MD 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 I I 43- 570.03 I $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 NOV 7 2011 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Invoice Appropriation 43- 404.00 P.O. 16551 Date: 11 /l /11 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 July 2011 2hrs August 2011 2hrs September 2011 2hrs October 2011 2hrs November 2011 2hrs December 2011 2hrs GRAND TOTAL 12 hours X Signature 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(a ,jndY-.rr.com Ssn: 352 -66 -9697 Medical License 01053866A 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)) 11/01/11 $1,200.00 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 N O. WA NO. Dr. Michael A. Kaufmann ALLOWED 20 IN SUM OF 5245 No. Co. Road 600 East Brownsburg, IN 46112 $1,200.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Clay Communications PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1115 I I 43- 404.00 I $1,200.00 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 Wednesday, November 02, 2011 Director Title Cost distribution ledger classification if claim paid motor vehicle highway fund