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Home My WebLink About230487 03/26/14 Coq CITY OF CARMEL, INDIANA VENDOR: 00351739 ® " ONE CIVIC SQUARE INTERNATIONAL ASSOC OF FIRE CHIEFGHECK AMOUNT: $... 2,600.00" ° CARMEL, INDIANA 46032 C/O EXPERIENT INC CHECK NUMBER: 230487 M�rovE°' PO BOX 4088 CHECK DATE: 03/26/14 FREDERICK MD 21705 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4357004 24573 2,600.00 REGISTRATION FEES .......... ir Y to S F., V Complete one form per registrant. InTaRMT, Iregainno mur mano e, Name IAFC Member Number Title Rank(Please choose one from the list of options below.): LI�a)Fire Chief Chief Officer U(c)Company Officer(Fire Officer) U(d)Staff Officer Q(e)Firefighter U f)Firefighter/Paramedic (9�EMS Officer (D(h)Emergency Management D(i)Other Organization Address(Isthisaddiess:Q Home C!Kepartmikt) city Stat Zip Country Ct 40-7 - -)-714-7 Kone Fax E-mail(Please complete to receive your confirmation and&nference updates.) Please indicate the educational sessions you will be attending by checking the box to the right of the corresponding number.For up-to-date conference information visit www.iafc.org/frm. PRE-CONFERENCE RATES 1 CONFERENCE RATES IAFC, E 400, 47 7$250- 8:00 am 5:00 pm, T11(2 day $200 R $ P $ 2 2 no am-5:00 pm P2 , �1150: �200 P 0 wednesday,April 30,,, 8:00 am-5:00 pm PZZ, $150, $no j:00,ipm.-5:00 pm W P25' $175 4:04 pm 500 pm -'P5 -$125 $175 8:0 P6 $125 $175 0 arn.�,'l 2:00 pm Total Registration Due(in U.S.Dollars): hurqsI May 1 8:00 am 6:60'pm _ -P7 $150 $200 (Total sum of Sections A+B) e. am=5:00 pm: P8 $150 $200 —�_Illr 3 T help us better serve you,please answer the following: 1.Type of department 3.What is your purchasing responsibility? IZI(a)volunteer dl(b)career U(c)combination Q(d) tribal Tj(a)final decision maker F_ b) research/specify U(e) airport U(f) industrial J(g) military Q(h) other FJ(c)recommend 1�1(d) significant influence 2.Size of population served 4.Is d is your first time attending the conference? �'a)0-9,999 U(b)10,000-49,999 J(c)50,000-99,999 (a)Yes ,j(b)No,I have attended for the past—years. (d)100,000-199,999 LJ(e)200,000 and up 11111 if,R! 1 ril"NK&VMV.VU0W1LGMMJ WIMPNOW,BRIM, 0 Check Enclosed(Please make checks payable to"IAFC,"in U.S.funds.) Purchase Order# (Copy of PO or form must be provided to process registration.) 0 Credit Card Q AMEX Ll VISA Fj_ MasterCard (if you are registering as a government employee,your credit card must have expiration date after 6/14 and your credit card will be charged three weeks prior to the conference) Card#(with CSV code) Expiration Date(Must be after 6/14) Name as it appears on card Signature Online:www.iafc.org/FRM Mail:IAFC c/o Experient,Inc.,P.O.Box 4088,Frederick,IVID 21705 All IAFC programs are accessible to persons with disabilities.If you require special accommodations Fax:301-694-5124 Questions:866-229-2386 or email FRM@experient-inc.com or auxiliary aids,please notify U5 of your needs in advance by calling 866-289-2386. .tstk` ^�' �.r r;t*K<.- ,t _ d!{� "� -°,.� - h•� 6 .) �..- ��.,#�i ..ar '��' a.`` `�,. - � .{-a;f ..3.^a -< •t��" t fi ''� � '*� .s < . r ti d N f +!:-tx� '�;; 'R.,a•.k..,.. „ - } K T{�;`+. � c � 3 ...`- b7� �s` i .}i ..�-�� ..� iFk§`k r'+.t..� t)1� +.�dt# F} -'' �.x�1'fz� y ~�.,„ � "`�.4 UREGISTRATIN OFORM , t f 4 z r. s �..,�'.:a_v,.�.�.__,s:',�.�].�._._v:szc4.....-w�'e,ss,....._...�,a�..;'�-n Complete one form per registrant. rivarwynae !• • I/lerNfTS ttilt3 ) 1 E//9S Name IAFC Member Number Title Rank(Please choose one from the list of options below.): U(a)Fire Chief rk(b)Chief Officer J(c)Company Officer(Fire Officer) J(d)Staff Officer U(e)Firefighter ❑(f)Firefighter/Paramedic O(g)EMS Officer r p(h)Emergency Management J(i)Other- CA ther 5.-A f 1'Vt t' I Fire ti 1 O t' � 61/ i C Or anization Address(Isthisaddress:J Home Department) city State Zip Country 317..S 71-�2(,c- 3 -Es w w o cA., ryie r) . �e z,/ Phone Fax E-mail(Please complete to receive your confirmation and conference updates.) 2 Please indicate the educational sessions you will be attending by checking the box to the right of the corresponding number.For up-to-date conference information visit www.iafc.org/frm. PRECONFERENCE RATES °.•° CONFERENCE RATES ° $i00 am S:OO;pin : P1(2 day) $200 $250c IAFC MEMBER:. ;'., 5400 .5475 $00 am-5:00 m P2 $150. $200, r r. w a v v a ae w, P igOAiMEMBER # r , : X5450 z x5525, £t. Wednesday April 30 8:00 am-5:00 pm, P3 $150 $200 11i00.pm-5Ogpm. P4 x $125 $175 . C z� ✓: 1:00 pm' 5:00 In P5 , $125 $175;'. a 8:00 am 12:00 pm •IP6 $125 $175', Total Registration Due(in U.S.Dollars):$ Thursday May t'�' 8:00 am-5:00 pm P7 $150 $200 (Total sum of Sections A+B) B;00 am,'5:00 pm :P8 '$1150 $200 D 0 r • ® 6 ° *..�.'- 4v;, n,a s,: �;:f.,: .. .::a'? ' ,a: �,�Y4� .,a ,w.-; - ate,' •4 To help us better serve you,please answer the following: 1.Type of department 3.What is your purchasing responsibility? J(a)volunteer Vb)career J(c)combination J(d) tribal J(a)final decision maker J(b) research/specify J(e) airport J(f) industrial J(g) military ❑(h) other J(c)recommend a1d) significant influence 2.Size of population served // 4.Is this your first time attending the conference? J(a)0-9,999 J(b)10,000-49,999 1�(c)50,000-99,999 O'Ca)Yes J(b)No,I have attended for the past years. J(d)100,000-199,999 J(e)200,000 and up Am 44 A ' ® 1 ® O • t O Check Enclosed(Please make checks payable to"IAFC;'in U.S.funds.) Purchase Order# (Copy of PO or form must be provided to process registration.) 0Credit Card JAMEX JVISA FJ MasterCard (Ifyou am registering as a government employee,your credit card must have expiration date after 6/14 and your credit card will be charged three weeks prior to the conference) Card ii(with CSV code) Expiration Date(Must be afrer6/14) Name as it appears on card Signature S All th Online:www.iafc.org/FRM Mail:IAFC c/o Ex erlent,Inc., P.O.Box 4088,Frederick,MD 21705 ** disabilities. es.Ify urequi espes are cial ac personsaccommodations 9 P �� disabilities.If you require special accommodations Fax:301-694-5124 Questions:866-229-2386 or email FRM@experient-inc.com or auxiliary aids,please notify us of your needs in advance by calling 866-289-2386. , L / ' ' REGISTRATION FORM_ 1 Complete one form per registrant. REGISTRATIONINF6IRMARON: Name IAFC Member Number Title Rank(Please choose one from the list of options below.): U(a Fire Chief U(b)Chief Officer U(c)Company Officer(Fire Officer) U(d)Staff Officer U(e)Firefighter :v(f)Firefighter/Paramedic ❑(g)EMS Officer O(h)Emergency Management ❑(i)Other r,(tv.e.i ,re �� a ( -1r/1C Organization Address(Is this address:U H me U Department) (O:T-nn:e C iG'egy — CISA City StateZip Country T 571'- a6,y0 !P4 �x21 CArrneI✓i •cq0 Phone Fax E- ail(Please complete to receive your confirmation and conference updates.) Please indicate the educational sessions you will be attending by checking the box to the right of the corresponding number.For up-to-date conference information visit www.iafc.org/frm. PRECONFERENCE RATES : �.• CONFERENCE RATES ; S;OO am-5;00 pm P7(2 day) $200 $250` IAFC MEMBER : .�; 5400 $475 8:00 am-5:00 pm P2 $150 $200 NON=MEMBER; ` 5450 h 5525 s s Wednesday,April 30 "8:00 am-5:00 pm P3' '$150 $200 1:00 pm .5:00 pm P4 $125 ., - $175 1:00 pm 5.00,pin P5 $125 $175 8.00 am-12:00 pm P6 $125 Total Registration Due(in U.S.Dollars):$ Thu isdagMay 1^ 8:00 am'_5:00 pm P7 $150 $200;:: (Total sum of Sections A+B) 8:00 am-5:00 pm. (S s $150 To help us better serve you,please answer the following: I.Type of department 3.What is your purchasing responsibility? U(a)volunteer I//(b)career ❑(c)combination U(d) tribal D(a)final decision maker ❑(b) research/specify •(e) airport U(f) industrial U(g) military U(h) other idl(c)recommend U(d) significant influence 2.Size of population served /� 4.Is this your first time attending the conference? U(a)0-9,999 U(b)10,000-49,999 3d(c)50,000-99,999 iiK(a)Yes U(b)No,l have attended for the past years. U(d)100,000-199,999 U(e)200,000 and up 4e • •• 011 • • • s O Check Enclosed(Please make checks payable to"IAFC;'in U.S.funds.) Purchase Order q (Copy of Poor form must be provided to process registration.) Credit Card ❑AMEX ❑VISA ❑MasterCard (If you are registering as a government employee,your credit card must have expiration date after 6/14 and your credit card will be charged three weeks prior to the conference) Card It(with CSV code) Expiration Date(Must be after 6/14) Name as it appears on card Signature • All th Online:www.iafc.org/FRM Mail:IAFC c/o Experient,Inc.,P.O.Box 4088,Frederick,MD 21705 disabilities. If you equineare special personsaccommodations disabilities.If you require special accommodations Fax:301-694-5124 Questions:866-229-2386 or email FRM@experient-inc.com or auxiliary aids,please notify us of your needs in advance by calling 866-289-2386. #` st s,4a.., q� 1 k�°`� REGlSTRATiON FORM -r � G..-.��;iu,__P.....,..:.w ___....�,.:_.,.,...-.....«a�•'..nu.._s..�.x...,.._::....'`�'.. .+_sa...�......�.L,;..:..^.��.....,,..w u,..:..__.-. ...:;:e.. �........_.,.�,.;_s 'k.�x.?..,��....�.. ...�.c-rte...,��`1`�.�,..,.,�... 4�,.�v�r-�..,�.+.._a�_.�'�,`co:T°a-»,-�,...a.�c.:.,t�."x1 Complete one form per registrant. 1111 rol L,I I ZI I • a ji F11 a • vt e y,r e Name IAFC Member Number Title Rank(Please choose one from the list of options below.): U(a)Fire Chief U(b)Chief Officer O(c)Company Officer(Fire Officer) O(d)Staff Officer U(e)Firefighter , Firefighter/Parameedic U(g)EMS Officer /U(h)Emergency Management U(i)Other Organization Address(Isthisaddress:U Ho a CI Department) City State Zip Country Phone Fax E-mail(Please complete to receive your confirmatiodand conference updates.) 2 Please indicate the educational sessions you will be attending by checking the box to the right of the corresponding number.For up-to-date conference information visit www.iafc.org/frm. PRECONFERENCE RATES �.• CONFERENCE RATES a B:OOam-S;OOpm,. P1`(2;day) $200 $250': IAF6`MEMBER, $400 "5475 F - 8:00 am 5:00 pm P2 $150 $200. k , NON.MEMBER 5450 ` 5525 Wednesday Aprif 3U .8:00 am 5:00 pm M 50$1 $200' "" 1:OO;pm-S:OO pm P.4 $125 $175„ . 1:00 pm 5.00 pm P5 $125 $175,. ` CI 8:00 am 12100 pm P6 $125,, $175'.:: l i�✓ . f_ Total Registration Due(in U.S.Dollars):$ Thursday May 1 ' $:00 am-5:00 pm .P7 $150 $200' (Total sum of Sections A+e) 8:00.am-5:00 pm P8 $150 $200 To help us better serve you,please answer the following: 1.Type of department 3.What is your purchasing responsibility? U(a)volunteer ii4b)career Q(c)combination U(d) tribal U(a).final decision maker U(b) research/specify U(e) airport U(f) industrial U(g) military U(h) other UK)recommend U(d) significant influence 2.Size of population served 4.Is this your first time attending the conference? •(a)0-9,999 U(b)10,000-49,999 U(c)50,000-99,999 U(a)Yes U(b)No,I have attended for the past years. •(d)100,000-199,999 U(e)200,000 and up 41.MWIVINK1111TY,M1114LINNIMI • ie O Check Enclosed(Please make checks payable to"IAFC;'in U.S.funds.) Purchase Order# (Copy of PO or form must be provided to process registration.) OCredit Card UAMEX ❑VISA UMasterCard (If you are registering as a government employee,your credit card must have expiration date after 6/14and Your credit card will be charged three weeks prior to the conference) Card N(with CSV code) Expiration Date(Must be after 6/14) Name as it appears on card Signature 0 ® ' Online:www.iafc.org/FRM Mail:IAFC c/o Experient,Inc.,P.O.Box 4088,Frederick,MD 21705 yy AIIIAFCes.Ify yous are ea personsaccommodations disabilities.If you require special accommodations Fax:301-694-5124 Questions:866-229-2386 or email FRM@experient-inc.com or auxiliary aids,please notify us of your needs in advance by calling 866-289-2386. VOUCHER NO. WARRANT NO. ALLOWED 20 IAFC c/o Experient Inc. IN SUM OF $ PO Box 4088 Frederick, MD 21705 $2,600.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 24573 I I 43-570.04 I $2,600.00 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 MAR 2 4 2014 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund 3rescribed by State Board of Accounts City Form No.201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 4n 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)) Small,Alverson, Fisher, Payne $2,600.00 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