204591 12/13/2011 CITY OF CARMEL, INDIANA VENDOR: 00353243 Page 1 of 1
ONE CIVIC SQUARE MICHAEL A. KAUFMAN MD CHECK AMOUNT: $1,600.00
CARMEL, INDIANA 46032 5245 NORTH CO. ROAD 600 EAST
�`"lsari ie BROWNSBURG IN 46112 CHECK NUMBER: 204591
CHECK DATE: 12113/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4357003 1,600.00 INTERNAL INSTRUCT FEE
Invoice
Appropriation 570 -03
P.O. Box 12455
Date: 12/6/2011 Q4
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
November 8
December 8
Grand Total 16
X
Michael A. Kaufmann, M.D.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Michael Kaufmann, MD
IN SUM OF
5245 North Co. Road 600 East
Brownsburg, IN 46112
$1,600.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# I Dept. INVOICE NO. ACCT /TITLE AMOUNT
Board Members
1120 f I 43- 570.03 j $1,600.00 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
DEC 12 2011
/7
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))
$1,600.00
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