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Home My WebLink About229456 2/25/2014 CITY OF CARMEL, INDIANA VENDOR: 366017 Page 1 of 1 1 � ONE CIVIC SQUARE ENVIROCERT INTERNATIONAL,INC CHECK AMOUNT: $75.00 CARMEL, INDIANA 46032 49 STATE STREET MARION NC 28752 CHECK NUMBER: 229456 CHECK DATE: 2/25/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 211 4462838 75 . 00 STORM WATER PHASE II C E R T I F I E D Erosion Sediment CESSWI Renewal Notice Storm Water 2014 - 2015 C S I' I N S P E C T O R KURT MAXWELL ANDERSON Amount Due: $75.00 ONE CIVIC SQUARE Date Due: March 31, 2014 DEPARTMENT OF ENGINEERING CARMEL, IN 46032 RETURN THIS FORM WITH YOUR PAYMENT Renewal Fee Details: - ------CESSWI#-1337............Annual_Rate:$75.00-................Years: 1.......:.......Amount Due:$75.00................:.........::.Status:Actio----- - - Professional Development Affirmation: Current Period: 3/23/2013-3/22/2015.......................................................................Requirement: 20 PDUs per 2 Year Period Due Date for PDUs:3/23/2015 Review your training records and select either YES or NO in response to the following statement: I HAVE COMPLETED PROFESSIONAL DEVELOPMENT REQUIREMENTS FOR THE CURRENT PERIOD: ❑ YES ❑ NO Sign and date in the space below. (See back page for explanation.) Kurt Maxwell Anderson Date Information U pdate: (Please mark this notice with any changes to your contact information.) Business Phone: (317)571-2308 Ext. Fax: (317)571-2439 Home Phone: (317)402-9774 Email: kanderson@carmel.in.gov Please list any professional titles that you currently hold (for example, PE, RLA): Payment Information ENTER YOUR PAYMENT INFORMATION ON THE REVERSE SIDE OF THIS NOTICE. 49 STATE STREET MARION, NC 28752 PHONE: 828.655.1600 FAX: 828.655.1622 WWW.CESSWI.ORG THE CESSWI CERTIFICATION PROGRAM IS A DIVISION OF ENVIROCERT INTERNATIONAL,INC. Kurt Maxwell Anderson CESSWI # 1337 One Civic Square Department of Engineering w. Carmel, IN 460321- -, Payment Information (Please write legibly) RETURN THIS SHEET WITH YOUR PAYMENT. Payment amount: (in US dollars) Payment method: ❑ Check/Money Order ❑Visa ❑American Express ❑ MasterCard ❑ Discover Make check payable to EnviroCert International, Inc. in US funds. Credit Card Number: - I - I I 1 - Expiration Date: m / m Card Security Code: Name of Card Holder Signature of Card Holder Address of Card Holder IMPORTANT! Check the reverse side of this form to ensure that the Professional Development Affirmation section has been signed and dated. Professional Development Affirmation Explanation Professional development is a fundamental component of the CESSWI program. To complete renewal,you must sign the affirmation statement(on the reverse side of this notice)regarding your compliance with professional development requirements. Failure to renew your certification by paying the renewal fee AND signing the affirmation statement is a basis for suspension of your certification. Checking YES means that you have completed the PDU requirements for the current period. We will advance your PDU period to the next two-year block and issue a new ID card. Checking NO means that you have NOT completed the requirements for the current PDU period. Your CESSWI certification will remain Active and a new ID card will be issued. However,we will NOT advance your PDU period to the next two-year block. If you need assistance in determining whether you have met the PDU requirements, please contact our office as shown on the reverse side of this notice. Remember, it is a violation of the Code of Ethics to knowingly provide false information to the CESSWI Administrative Office. (See CESSWI Certification Procedures and Standards, Article II,Section 4, Item B.2 for details.) Note,the CESSWI Council has changed the PDU requirement to 20 PDUs per 2 year period. The previous requirement was 10 PDUs per year. This was done to allow you more flexibility in meeting the PDU requirement. 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 EnviroCert International Purchase Order No. 49 State Street Terms Marion, NC 28752 Date Due Invoice Invoice Description Date Number (or note attached invoice(s)or bill(s) Amount 2/11/2014 0 CESSWI Renewal $ 75.00 Total $ 75.00 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 NC WARRANT NO. EnviroCert International ALLOWED 20 49 State Street IN SUM OF $ Marion, NC 28752 $ 75.00 ON ACCOUNT OF APPROPRIATION FOR Board Members Po#or DEPT# INVOICE NO. ACCT#/TITL AMOUNT DEPT# I hereby certify that the attached invoice(s), 0 0 211-4462838 $ 75.00 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 2/24/2014 Signature City Engineer Cost Distribution ledger classification if Title claim paid motor vehicle highway fund