The URL can be used to link to this page

Home My WebLink About229908 03/12/14 C,9 . CITY OF CARMEL, INDIANA VENDOR: 366017 ® ONE CIVIC SQUARE ENVIROCERT INTERNATIONAL, INC CHECK AMOUNT: $ .. .... 75.00' CARMEL, INDIANA 46032 49 STATE STREET CHECK NUMBER: 229908 MARION NC 28752 CHECK DATE: 03/12/14 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 Municipal Separate - Storm Sewer System g S4S eel Notice ,DUMP NO WASTE /'� 4>4 2014 a 2015 4 `� S P E C I A L I S T JO=HN.G•HARRITYTHOMAS Amount D..ue:, $75.00 11576 CREEK SIDE LANE Date Due: March 31, 2014 CARMEL, IN 46033 RETURN THIS FORM WITH YOUR PAYMENT Renewal Fee Details: CMS4S# 139 ...........Ann.lual Rate: $'_ ^0 .... Years: 1.............Amou'rt Due:$75.00..................:..:..?Latus:.ACLiVe -- Professional_Development:Affirmation:._. Current Period: 3/23/2013-3/22/2015 .................................................... Requirement::30.PDUs�per,2.Year-Period Due Date for 30 PDUs:3/23/2015 Review your tFaining records and select either YES or NO-in response to the following statement: I HAVE COMPLETED PROFESSIONAL DEVELOPMENT REQUIREMENTS FORTHE CURRENT PERIOD: ❑ YES %NO Sign and date in the space below :(Seeback page for_explanation) John Gharrity Thomas Date Information Update: ,(Please-mark this-notice,with any.changes to your contact information.) Susifie s,Phone: •(317)571-2314 Ext. _ Fax: (317)571-2439 ' I IVllla.. 1 I-IVnG'.-_.('.ii/)-{J l.J-1iJ V' '• :_. -. �� ". � • � ' � � �. .. .. .. Email: jthomas@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.CMS4s.ORG THE CMS4S CERTIFICATION PROGRAM IS A DIVISION OF ENVIROCERT INTERNATIONAL,INC. F , r JohnxGha'rd Thomas CMS4S # 139 11576 Creek Side Lane �x T ' Carmel, :IN 46033 k ' ' . ... .. � .. . 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: - - - Expiration Date: 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 develo.pment`is a'fundaniental'com'pornent of the'CIVIS4S'program1. "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 t r`equieements_for the current'PDU period. Your CMS4S certification will remain Active and anew 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-asshown on the reverse-side-"f this notice °'Rem'ember;it is-a°'violation=of the Code ofi Ethics to - =----- knowingly provide false information to the CMS4S Administrative Office. (See CMS4S Certification Procedures and Standards,Article II, Section 4, Item B.2 for details.): 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 1/0/1900 0 CMS4S 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. s i EnviroCert International ALLOWED 20 49 State Street IN SUM OF $ Marion, NC 28752 $ 75.00 ON ACCOUNT OF APPROPRIATION FOR Board Members Po#or 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 3/10/2014 nature City Engineer Cost Distribution ledger classification if Title claim paid motor vehicle highway fund