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Home My WebLink About209586 06/05/2012 CITY OF CARMEL, INDIANA VENDOR: 163730 Page 1 of 1 ONE CIVIC SQUARE INST FOR PUBLIC SAFETY PERSONNEL' CARMEL INDIANA 46032 251 E OHIO STREET SUITE 1000 L ECK AMOUNT: $1,470.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 209586 CHECK DATE: 615/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4340703 26182 2012PSY0503 750.00 EVALUATIONS 1110 4341999 26182 2012PSY0503 720.00 EVALUATIONS Institute for Public Safety Personnel, Inc. Invoice 251 East Ohio Street, Suite 1000 Indianapolis, IN 46204 DATE INVOICE 5/12/2012 2012psy0503 BILL TO Carmel Police Department 3 Civic Square Carmel, IN 46032 DESCRIPTION QUANTITY RATE AMOUNT Applicant psychological evaluations for 2 360.00 720.00 Goldstein, Seth Navarrete, Juan Incumbent psychological fitness for duty 1 750.00 750.00 evaluation for B.H. on 4/9/12 Make checks payable to: Total $1,470.00 Insititute for Public Safety Personnel, Inc Phone Fax E -mail 317 687 -8910 317 687 -9490 jeff @ipsp.net C o INDIANA RETAIL TAX EXEMPT PAGE ity ®I' Carmel CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 26962 35- 60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. 'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 5f2092 Institute for Public Saf Pomonnol, Inc. CumGI Polico Wpartmont VENDOR SHIP 3 CI spina 259 East Ohio Street, 0ulte 90M TO Carmol, IN 46032 Indianapolis, IN 46204 (397) 599 2556 CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 43-407.03 1 Each fit for duty psychological $750.00 $750.00 Sub Total: $750.00 Account 43496M 2 Each psychological evaluations $360.00 $720.00 Su b Total: $720.00 Ps ph for Seth Goldstein Juan N te 0 Send Invoice Io Carmel Police Depadment Attn: Teas@ Anderson 3 Civic Square Carfnel, IN 46032= PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT ,armei Police Dept. PAYMENT $9,470.00 A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. ,THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY SHIPPING LABELS. I Chief of Police THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK-TREASURER SIGN DOCUMENT CONTROL NO. 2 618 2 AN A.P.V. COPY -SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO. WARRANT NO. ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I 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 20 Signature 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)) 05/12/12 2012psy0503 fit for duty evaluation $750.00 05/12/12 2012psy0503 psychs for applicants $720.00 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 Institute for Public Safety Personnel, Inc. IN SUM OF 251 East Ohio Street, Suite 1000 Indianapolis, IN 46204 $1,470.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 26182 2012ps 0503 43- 407.03 $750.00 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 26182 2012psy0503 43- 419.99 $720.00 materials or services itemized thereon for which charge is made were ordered and received except Wednesday, May 30, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund