HomeMy WebLinkAbout229908 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
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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