169973 03/18/2009 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: $3,000.00
BROWNSBURG IN 46112 CHECK NUMBER: 169973
CHECK DATE: 3/18/2009
DEPARTMENT ACCO PO NUM BER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4340400 600.00 CONSULTING FEES
1120 4357003 2,400.00 INTERNAL INSTRUCT FEE
I
Invoice
Appropriation 570 -03
P.O. Box 12455
Date: 3/10/09
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 meetings as requested
Date Hours
January 8
February 8
March 8
Grand Total 24
Michael A. Kau .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))
Medical Director Fees $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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Michael Kaufmann, MD
IN SUM OF
5245 North Co. Road 600 East
Brownsburg, IN 46112
$2,400.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 43 570.03 $2,400.00 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
MAR 16 2009
A
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Invoice
Appropriation 43- 404.00
Date: 3/15/09
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
January 2009 2hrs
February 2009 2hrs
March 2009 2hrs
GRAND TOTAL 6 hours
X
Signature
Michael A. Kaufmann, M.D.
Printed Name
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))
03/15/09 I I I $600.00
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
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. ACCT #/TITLE AMOUNT Board Members
1115 43- 404.00 $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
Monday, March 16, 2009
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund