HomeMy WebLinkAbout231605 04/23/14 u!C,gyf
q`'' x CITY OF CARMEL, INDIANA VENDOR: 00351564
`J ONE CIVIC SQUARE GARY CARTER CHECK AMOUNT: $*******129.00*
CARMEL, INDIANA 46032 4748 BISHOPSGATE DR CHECK NUMBER: 231605
1,y.,_ o, CARMEL IN 46032 CHECK DATE: 04/23/14
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4343004 43.00 TRAVEL PER DIEMS
1120 4355100 71.00 PROMOTIONAL FUNDS
1120 4358300 15.00 OTHER FEES & LICENSES
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Attendee Name: Ni
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Phone:
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EVENT REGISTR
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Badge ID:
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REGISTRATIONINFORMATION
April 7-12, 2014
Indiana Convention Center & Lucas Oil Stadium
Indianapolis, Indiana
Registration Sponsor:
= ATHLETIC GEAR FOR FIREFIGHTERS.'
REGISTRATION HANDS-ON TRAINING INFORMATION
■ Fully complete the registration form.Incomplete registration forms ■ Register early.Hands-On training class sizes are limited.
will be returned for complete information. ■ Hands-On training participants must register and report to Staging
■ Placement in Hands-On Training(H.O.T.)classes is not reserved by 6:30 a.m.
until registration form is fully completed and payment is received. ■ Signed liability waivers are required for all Hands-On training.
■ Payment for all Early Bird registrants must be received by February Visit www.fdic.com to print a liability waiver.
27,2014.Registration and payment received after February 27, ■ Full turnout gear and/or technical rescue gear is required for
2014 is subject to full registration fees. certain Hands-On training.(See"Important Notes for H.O.T.
■ Each attendee must be individually registered.Single registrations Attendees"at www.fdic.com.)
may not be separated or shared among multiple attendees. ■ Lunch is provided for all Hands-On training attendees
■ There is no refund for partial-day attendance. ■ SCBA will be provided when necessary.
■ If selecting 4 hour Hands-On training in the morning,you can only
IF PAYING WITH PURCHASE ORDER(PO)-Purchase order must have select a Hands-On training for the afternoon.You cannot combine a
a credit card guarantee or the registration will be forfeited.Payment Hands-On training and a Pre-Conference workshop on the same day.
must be received by February 27,2014 in order to receive the Early ■ H.O.T.Class Pricing: 4-hour are $150 each and 8-hour are$250
Bird rate.A PO is not considered a payment.Payments must be each in addition to the registration fee.
received prior to the event or upon arrival to receive your badge.
PRE-CONFERENCE WORKSHOPS INFORMATION
' °�='<"'�`` °`yam;"'�''� ■ Morning Pre-Conference workshops begin promptly at 8:00 a.m.
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■ Afternoon Pre-Conference workshops begin promptly at 1:30 p.m.
Lunch is NOT provided for Pre-Conference workshop attendees.
:. _ e e e ■ If selecting a 4 hour Pre-Conference workshop in the morning,
you can only select aPre-Conference workshop for the afternoon.
You cannot combine a Hands-On training and a Pre-Conference
workshop on the same day.
_. `^ = 3 ■ Pre-Conference workshops are$125 each in addition to the
t _ registration fee.
www.fdic.com
Attendee Name:
FIDIC 2014
Phone:
EVENT REGISTRATION IlI
Badge ID: g,
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ATTENDEE INFORMATION (Enter this information as you would like it to appear on your badge)
77,
First Name Last Name Title
Department/Company(Maximum 30 Characters)
Address(To mail badge and conference information)
Address 2(Suite#,etc.) Country
City State Zip
Phone Fax E-mail(A unique Email is required for processing registration)
Cell(Required for Emergency Response Communication)
Rank/Title Do you read Fire Engineering?
❑(01)Chief of Depart. ❑(07)Firefighter/Paramedic ❑(0 1)Yes ❑(02)No
❑(02)Staff Chief ❑(08)Firefighter/EMT
❑(03)Other Officer ❑(06)other If yes,whose copy do you read?
❑(04)Firefighter (please specify) ❑(01)1 subscribe ❑(02)My department's copy
❑(05)Training Officer ❑(03)1 read a co-workers copy
Job Function(Check all that apply) Do you read Fire Apparatus&Emergency Equipment magazine?
❑(01)Management ❑(08)Public Education ❑(01)Yes ❑(02)No
❑(02)Training ❑(09)EMS
❑(03)Prevention ❑(10)Haz Mat How many years have you attended FDIC?
❑(04)Suppression ❑(11)Rescue
❑(05)Investigation ❑(13)Wildfire I am visiting the FDIC 2014 exhibits
❑(06)Maintenance ❑(12)Other to obtain information on:(Check all that apply)
❑(07)Communication (please specify)
❑(01)Ambulances ❑(12)Hand Tools&Forcible Envy
Purchasing Responsibility ❑(02)Apparatus& ❑(13)HazMat Products
❑(04)Approve ❑(02)Recommend Apparatus Accessories ❑(14)Incident Management/
❑(01)Purchase ❑(03)Specify ❑(03)Badges,Emblems Accountability Systems
&Accessories ❑(15)Insurance/Financial
Are you a member of a purchasing committee? ❑(04)Breathing Apparatus/Air Institutions/Consulting Services
Systems/SCBA&Supplies ❑(16)Miscellaneous/Other
❑(1)Yes ❑(0)No
❑(05)Communications/Radios/ ❑(17)Monitors&Detectors
Dispatch Equipment ❑(18)Nozzles,Hoses,Reels
Type of Department
❑(os)Computer Services/Software &Couplings
❑(01)Volunteer ❑(04)Industrial ❑(07)Water,Diving&Ice Rescue ❑(19)Protective Clothing(PPE)/
❑(02)Career ❑(05)Military Equip.&Accessories Apparel
❑(03)Combination ❑(06)Other ❑(08)Educational Materials/ ❑(20)Pumps/Gauges
Career/Vol (please specify) Colleges/Training Services ❑(2 1)Rescue Tools&Equipment
&Equipment ❑(22)Rapes,Chains,Safety Belts
Population Served by Department ❑(09)EMS Equipment&Supplies &Accessories
❑(01)Under 2,500 ❑(05)50,001-100,000 ❑(10)FOAM,Environmental ❑ (23)Sirens,Alarms&
❑(02)2,501-10,000 ❑(06)100,001-500,000 Products,CAF Units Signaling Devices
❑(03)10,001-25,000 ❑(07)Over 500,000 ❑(11)Fans/Portable Generators ❑ (24)Thermal Imaging Cameras
❑(04)25,001-50,000 &Accessories ❑ (25)Wildfire Rescue Equip.&Access.
www.fdic.com
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AND PRE-CONFERENCE WORKSHOPS:
Monday,April 7, 2014 ✓'vt_ Mon ay,�prsa
Hands-On Training }; -r, ..
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4-Hour Hands-On Training: 4-Hour t?re=Confereotie Workshops:
Monday,April 7,8:00 a.m.-12:00 p.m.. . . . . . . . . . . . . . . ($150) Monday;April.7,.8:00 a.m:42:00 p.rri.:'. ($125)
1st 2nd 3rd 4th 5th 1st 2nd 3rd Ah 5th' -
❑ ❑ ❑❑❑ 01MA Aerial and Tower Operations ❑ ❑ ❑'❑ ❑ 20MA Building the Foundation,of a_ WinningTeam -
❑ El EI ❑ 02MA Conventional Forcible Entry [I0 El El ❑ 21 MA Coaching&'Mentoring:The Forgotten Elements of Leadership ,
❑ ❑❑ ❑ ❑ 03MA Engine Company Essentials:Getting Water on the Fire! ❑ O ❑ O 0 22MA Command and Contro'k.We Need to Do It Better and Safer
❑ ❑ ❑ ❑ ❑ 04MA Flashover ❑ ❑ ❑'d,❑',23MA Company Officer Developmenti,Lead from the Right.Seat;',•
11 ❑ ❑ El05MA Heavy Vehicle Extrication 0 ❑ ❑.0 0 24MA Designing a Safe and Effective Emergency Response'Plan:
C1 El El El El06MA KeepingYourself Alive 0.0.0;q P,25MA Developing Preplans and Simulation Training Using'YourPlans
SOLD OUT 07MA Man vs.Machinery [1 1-1 [1 El 0 26MA Extrication Zone:Hybrid/N6-w VehicleTechriology
❑ ❑ ❑ ❑ ❑ 08MA Rescue and Squad Company Operations on the Fireground ❑ ❑ ❑ 0 027MA Fireground Scenario Worksiiop.,:..
❑ ❑ ❑ ❑ ❑ 09MA School Bus Extrication and Rescue ❑ ❑ ❑ ❑.❑ 28MA High-Rise,Operations-.Strategic;ta8cal;and Task Level
SOLD OUT 10MA Vehicle Extrication ❑ ❑ ❑ ❑•29MAImproving,Behavioral-Healththrough;Betteilnterpersonal
❑ ❑ ❑ ❑ ❑ 11MA Vent-Enter-SearchCommunications
.
❑ ❑:p:0,30MA.In' uctoe andlraining Oft&Bootdamp r•
4-Hour Hands-On Training: C111 1111 p 31MA Intelligent'FireAperations:'BeAggressive But Smart ",
Monday,April 7,1:00 p.m.-5:00 p.m. . . . . . . . . . . . . . . . ($150) p ❑ 0,0 p'32MA-Know YourSmoke:The.Comprehensive Dangers_,-
1st 2nd 3rd 4th 5th El ❑ El [I ❑'33MA Leaderstfip Development leaders hip'Excellence
❑ ❑ ❑ ❑ ❑ 01MP Aenal and Tower Operations ❑p ❑.p ❑ 34MA,ModermTrainingTechniquesf6r.TacticalSuccess -4
❑ ❑ ❑ ❑ ❑ 02MP Conventional Forcible Entry -❑❑ C1 013 35MA Must-Have Policies for,Every Fire Department,
❑ ❑ ❑ ❑ ❑ 03MP Engine Company Essentials: Getting Water on the Fire! ❑.p-❑ ❑ ❑ 36MA Surviving the Fireground
❑ ❑ ❑ ❑ ❑ 04MP Flashover ❑ ❑ ❑ 0-� 37MA Surviving Utility-Emergencies and�Fires
❑ ❑ ❑ ❑ ❑ 05MP Heavy Vehicle Extrication ❑ p [I ❑ ❑ 38MATruck Company A to Z
❑ ❑ ❑ ❑ ❑ 06MP KeepingYourself Alive ❑.❑ ❑ ❑❑ 39MA Wood Frame&Ordinary Construction:Principles and Hazards
00000 07MP Man vs.Machinery
❑ ❑ ❑ ❑ ❑ 08MP Rescue and Squad Company Operations on the Fireground 4-H our Pre ConfereoCe Workshops:
❑ ❑ ❑ ❑ ❑ 09MP School Bus Extrication and Rescue Monday,AOrii 7;_3:30 0;m:-5:30 p.m. ($125)
SOLD OUT lOMPVehicle Extrication
--ist2nd-3rd 4th 5th
❑❑ [3 ❑❑ 1 1M Vent-Enter-Search -0 O [I l7 ❑ 40MP-25 to Survive":,Reducing Residential Injuries and'LODDs
❑ 0 O ❑0 41MP Be a Leader,Not-Just a Position, _
8 Hour Hands On Training: ❑ ❑ ❑ 0 ❑ 42MP Big Box Store Firefighting Strategies and Tactics
Monday,April 7,8:00 a.m.-5:00 p.m. . . . . . . . . . . . . . . . ($250) ❑ ❑ ❑ ❑ [:143MP Blink:Making Critical Fireground Decisi%ons- ;
1st 2nd 3rd 4th 5th .0 ❑0 0 O .44MP Chief Problem Solver-
❑ ❑ ❑ ❑ 1112M Collapse and Void Search Rescue ❑ ❑ ❑ ❑.❑;45MP Company Officer Development:Red Flags on the F.ireground
❑ ❑ ❑ ❑ ❑13M Conducting NFPA 1403 Live Burn Training ❑ ❑ ❑ ❑ ❑.46MP Drill Development The.Next Level
11 El 11 El 14M Grain Bin Rescue and Engulfment Operations ❑ 13 0.11 47MP Extrication Zone:Principles of Extrication.
SOLD OUT 15M Live Fire:First-Due Tactics ❑ ❑ ❑ El ❑.481AP Firefighting:Career orvolunteer,"The UlVmateTeam,Sport°
SOLD OUT 16M Nozzle Forward ❑ ❑ ❑ ❑ ❑ 831VIP First-Due TacticsTake;Home Package.
❑ ❑ ❑ ❑ ❑17M RIT Combat Drills 0'❑ 0'0 El49MP Leadership Development Five;Alarm-Leadership.--. -
❑ 11 C1 ❑ 0 18 Truck Company:Essentials ❑ ❑_❑ ❑ ❑ 5OMP Leading in ChangingTmes:Three Windows for Successful
Growth
❑ El ❑ ❑19M Urban Essentials ;
❑ ❑ ❑ ❑ (] 51MP Lessons Learned from the SC Fatal Sofa Store Fire
❑ EI-El ❑ ❑ 52MP.M6dern Buildings:"Recipe forheefighter Deaths and,-Injuries
❑.Thiee-Day Workshop:Monday,April 7,8 a.ni.•5 p.m.;Tuesday,April 8,8 a.m.•5p.❑.❑ 0 El 53MPNIMSwd ICS:Strategies and Tactics for Large-Scale Incidents
p.m.;Wednesday,April 9,10:30 a.m.-5 p.m. El ❑ ❑ [1,11 54MP Teaching Adults:Evidence-Based Best Practices
FDIC-Blue Card Simulation Laband Conference ❑ ❑ ❑ ❑ ❑ 55MPThink"Like'a!'6ident Commander
SOLD OUT Three-Day Evolution:.Sunday,A0ri46,8 a.m.-S,p.m.; [i [i [I t] C1 56M'PThis House Rocks!The Place•Everyone Wants to Work
Monday,April 7,8 a.m.-5 p.m.;Tuesday,April 8,8 a.m.-5 p.m. ❑ ❑ ❑ ❑ ❑ 57MP Understanding,Surviving,and Mastering the Modern
FDTN Engine Company,Operations I&FDTN Truck Company Operations 1 Residential Fiiefight
❑ ❑ ❑ ❑ ❑ 58MP Ventilation Flow Paths&Fire Growth:A Review of Recent LODDs
www.fdic.com
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Attendee Name:
DIC 2014,
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TRAINING / PRE-CONFERENCE WORKSHOPS
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Tuesday,April 8, 2014 : . ~ uesay. pa8- ;;2.®;1 :,r=
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4-Hour Hands On Training: 4Hour Pre`-Conference]W6rksfi60- .
Tuesday,April 8,8:00 a.m.-12:00 p.m. . . . . . . . .($150) Tuesday{April 8,8:00 a.m:=12:00 p.m.: .(5125)
' ..
1st 2nd 3b 4th 5th 1st 2nd 3rd,th 5th +r'-
❑ ❑ ❑❑❑ 01TA Aerial and Tower Operations ❑:❑ O❑'[I59TA.Building the Ladder:Officer Development Programs
❑ ❑❑❑ ❑ 02TA Conventional Forcible Entry O.❑'❑ ❑_ ❑ 60TA Corrip4..Offcer Development:Developing&Inspiring Exceptional Fire -
El El ❑ ❑ 03TA Engine Company Essentials: Getting Water on Officers
the Fire! ;El d,1>.� 0 61TA'DC Fire:•.Leadershi and Accountabilityr ,
❑ ❑ ❑ ❑ ❑ 04TA Flashover ❑ ❑ ❑,0 62TA Decision Making at Commercial Building Eiies
❑ ❑ ❑ ❑ ❑ 05TA Heavy Vehicle Extrication b,Ei a[i0 63TA DnII Ground InstrucforAcademy,
❑ ❑ ❑ ❑ [106TA KeepingYourself Alive E O-0 0 .64TA Engine Company Operations:Why We,Fail'a_nd How We Succeed
❑ ❑ ❑ ❑ ❑ 07TA Man vs.Machinery ❑ q.o El l7.65TA Essentials.of Fire Irivestigalion
El El [I [I C108TA Rescue and Squad Company Operations on 11 D' ❑ 0 66TA Extrication.Zone'Large:Trdcks%'Traileis/Buses
the Fireground E].-O` ❑'O 67TA,Firregrou_d Incident Action-Plaa-Development and Deploymenf'
❑ ❑ ❑ ❑ ❑ 09TA School Bus Extrication and Rescue 0., ,El p'68TA Fireground.Strategies:Command,Control,;arid Accountability,:''..
SOLD OUT IOTA Vehicle Extrication ❑ ❑ ❑.� O'69TA Implementing a SuccessfuITraining Program. ='Y
❑ ❑ ❑ ❑ ❑ 1 1T Vent-Enter-Search ❑ p 0-E];❑ -70TH Leadership Development:;Leadership in tfie Reai;Wodd_��
❑ ❑ ❑ 71TA;Lea`dership So Everyone Goes Home
C1 bb El El 72-TA Managing Rescue and Disaster Operations,? ;'r,, ;,.;,.,`�• '.
4-Hour Hands-On Training: ❑ ❑ O:�❑ 73TA'Mbderh Fire Dynamics from'Concepts to Reality_.
Tuesday,April 8,1:00 p.m.-5:00 p.m. . . . . . . . . . ($150) ❑- ❑ El74TA Pritle.and gwnership:The Love for the Job;`:
1st 2nd 3rd 4th 5th 011 ❑ 1175TA Reading Buildings:The Rapid Street.Approach
❑ ❑ El El El01TP Aerial and Tower Operations ❑"� ❑.❑'❑-76TA Tactical&Strategic Perspectives of:ResidentiaI'Fires:Com mand'&Fire Attack. .
El ❑ C3 ❑ ❑ 02TP Conventional Forcible Entry . ❑ El 0❑ ❑ 77TATrie'Role'of the EMS Provider in tfie.Large-Scale Incidents
C3 El C3 ❑ ❑ 03TP Engine Company Essentials: Getting Water on ❑ 0 ❑❑ ❑ 78TA Volunteer&Combination Fire'DepartmentManagers Academy
the Fire! .47Hour Pre=Conference Workshops:
❑ ❑ 000 04TP Flashover Tuesday,Aril 8 1:30 m.-5_:30 in. . . . . . . . $125
❑ ❑ ❑❑❑ 05TP Heavy Vehicle Extrication p ' P' P• • ( �,
❑ ❑ ❑❑❑ 06TP KeepingYourself Alive ist2nd 3rtl 4th SN
El.
❑ ❑ ❑ ❑❑ 07TP Man vs.Machinery 0 0 11 'El 79TP Company Officer Development:Fireground Decision Making for Suburban
. Company Officers.
❑ ❑❑❑ ❑ 08TP Rescue and Squad Company Operations on ❑:❑_D 0 ❑ 80TP Drills You're Not Going to.Find in Books`
the Fireground '
❑ ❑ C1 11 09T School Bus Extrication and Rescue
❑ 0,0_11 81TP Extrication Zone;EMS.Aspects
SOLD OUT lOTPVehicle Extrication ❑-El.E 0 El82TP Fire Officer Survival in Ouarters.and on the Scene;:
❑ ❑ ❑ ❑ ❑ 11TP Vent-Enter-Search ❑ ❑ 0❑-❑ 84TP Getting the Most from Your Incident Simulation Software:
❑ ❑.0❑-0 85TP Hazmat Initial Approach and Actions =
❑:❑ ❑.❑ ❑ 86TP High_Tech Highways: Responding to.Hybn and'EV Incidents
❑ ❑ ❑ ❑ ❑ 87TP How,to'Nail-Your First-Due Strategic Resporisibility . '
8-Hour Hands-On Training: ❑'❑ O ❑ ❑ 881P Keeping Your Firefighters from.Getting Kille"d
Tuesday,April 8,8:00 a.m.-5:00 p.m. . . . . . . . . . ($250) ❑ p ❑•Q ❑ 89TP Leadership Development:Inspiring Leadership for.Today's Fire Service
1st 2nd 3rd 4th 5th ❑ O.b ❑ ❑ 907 Modem Fire Attack P6nciples:.Strateg c&Tactical Perspectives
❑ ❑ ❑ ❑ ❑ 12T Collapse and Void Search Rescue ❑ ❑'❑'❑,EY 91TP Next Generation.Tactics and:Command.
❑ ❑ ❑ ❑ ❑ 13T Conducting NFPA 1403 Live Burn Training ❑ ❑'❑ ❑-❑ 92TP No Brainer Management
❑ ❑ ❑ ❑ ❑ 14T Grain Bin Rescue and Engulfment Operations p'❑pi❑ ❑ 931P Specifying Fire Apparatus:Back to Basics
SOLD OUT 15T Live Fire:First-Due Tactics ❑ ❑ ❑ ❑ p-94TPTacti6al and Strategic.Perspec&es of Reside 6l Fires'Search and Ventilation '
SOLD OUT 16T Nozzle Forward ❑:❑ 0.d,❑ 95TPTechniques and Strategies'for,Maintaining Mental/Psychological Preparedness
❑ ❑ ❑ ❑ ❑ 17T RIT Combat Drills ❑ ❑.❑ ❑ ❑ 96TP The Artof Reading Smoke 2014
SOLD OUT 18TTruck Company:Essentials ❑ ❑ ❑ EI-E] 97TPWhat Do You See/1-1660 What does It Mean?
❑ ❑ ❑ ❑❑ 19T Urban Essentials
www.fdic.com
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C6NFERENCES i EXHIBITS REGISTRATIONFORM
REGISTRATION FEES (Please select only one of the following) GROUP PLANS
Fully paid Fully paid ❑ Group Plan 10(up to 10 members/employees) $4,950
on or before after (10%off the price of 10 individual full conference attendees)
2/27/14 2/27/14
❑ Group Plan 20(11 to 20 members/employees) $9,350
❑ Hands-On Training Premium Package $550* $700* (15%off the price of 20 individual full conference attendees)
Includes all general sessions,classrooms&exhibits.
May register up to 16 hours of Hands-On Training and/or Pre-Conference Workshops Larger Group Plans are Available(Contact Registration for Details)
Additional per class costs listed on Registration pp 3&4.
......................................................................................
i ❑ Two-Day Hands-On Training& $200* $250* 1 0• o
Pre-Conference Workshops Only
Includes all general sessions.(DOES NOT INCLUDE CLASSROOMS OR EXHIBITS.)
May register up to 16 hours of Hands-On Training and/or Pre-Conference Workshops Registration Fee$
Additional per class costs listed on Registration pp 3&4.
Hands On Training Class Price from Registration Pages 3&4$
......................................................................................
❑ FDIC Blue Card Simulation Lab and Conference $1,000 $1,000 Total Due$
Includes 3-day workshop,Monday-Wednesday,All general sessions,classrooms,& ••••••••••••••-•-•••••-•••••„ "”"""""•-•"'
exhibits.Limited space available. PAYMENT
......................................................................................
All Registration Fees must be paid in full prior to event for admittance.
❑ FDTN Engine Company Operations 1 $1,200
Includes 3-day Hands-On Training,Sunday-Tuesday,all general sessions,classrooms, ❑ Check payable to PennWell/FDIC14.
&exhibits.Limited space available.
❑ Signed purchase order with credit card guarantee.
"-""""""""""""•'•.......••'.•""".'-••.'.."•••.",,,,"..........• Please include credit card details below.
❑ FDTN Truck Company Operations 1 $1,200
Includes 3-day Hands-On Training,Sunday-Tuesday,all general sessions,classrooms, Charge my credit card: El MasterCard Visa
❑
Discover
&exhibits.Limited space available. American Express ❑
...................................................................................... Card number
❑ Individual Full Conference $550 $700
Includes all general sessions,classrooms&exhibits Exp.date
.......................................................I............................ Name on card
❑ One-Day Conference $325 $375 Signature
Includes general session and classrooms on selected day only&all three days of exhibits
................................................................................
❑Wed.,Apri110 ❑Thurs.,April 11 OR ❑Fri.,April 12
.............................................................................. 4 Ways to Register
❑ Exhibit Package $75 $75 1. Online:www.fdic.com 4. Mail to:
Includes exhibition only all exhibit days,Thurs.-Sat.,April 10-12 2. Fax to:+1-888-299-8057 PennWell/FDIC14
or+1-918-831-9161 Registration Department
P.O.Box 973059,
❑ One-Day.Exhibits Only $40 $50 3. Email:registration@pennwell.com Dallas,TX 75397-3059
Includes exhibits on selected day only.
Questions?Please call:+1-888-299-8016 or+1-918-831-9160
❑Thurs.,April 10 ❑Fri.,April 11 OR [I Sat.,April 12
......................................................................................
................................................................................
ElSpouse Exhibits Only $20 $25 Cancellation Policy
Includes exhibition only all exhibit days.Thurs.-Sat.,Apri110-12 Cancellations must be received in writing before February 27,2014,in order
to receive a refund,minus a$115 administrative charge. After February 27,
Name for Badge: 2014,refunds are not available. Substitutions may be made at any time by
notifying the registration office in writing.
II l ................................................................................
Fire Engineering Subscription
Your registration fee includes a 1-year print subscription to Fire Engineering
g
magazine.Check here if you DO NOT wish to receive the subscription.You will
not be refunded the$25.00 print subscription rate.❑
o wx"_3;r � PROMOTIONAL CODE:
www.fdic.com
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))
$71.00
$43.00
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
Gary Carter
IN SUM OF $
$114.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 43-551.00 $71.00 1 hereby certify that the attached invoice(s), or
1120 43-430.04 $43.00 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
APR 2 1 201
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
' r
=9_ a. Bureau of Motor Vehicles
F "} R Customer Transaction Receipt IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
r ASEI State Form 51717 (4-04)
r ,
Branch: VEHICLE SERVICES- REGISTRATIONS Date: 4/17/14 Time: 2:42:10 pm EDT
('19
Visit ID: 297773
Visit Customer: CITY OF CARMEL FIRE DEPT
Transactions
Trans ID IPINI Trans Type Trans Subtype Amount
234019009 Title - Initial Title Issuance New $15.00
234019188 Registration - New Motor Vehicle Registration New $0.00
Subtotal: $15.00
Sales/Use Tax: $0.00
Credit Applied $0.00
Total: $15.00
Payment Method Amount Authorization Number Name
CREDIT $15.00 06254B
Total Due: $15.00
Amount Paid: $15.00
Change Due: $0.00
Within 10 business days, you will receive your registration or title through the United States mail. You will be able to track the
progress of your registration or title by using your PIN number listed above when calling the BMV Customer Service Center at
888-myBMV-411 (888-692-6841).
If you have questions or comments, please call our Customer Service Center at 888-myBMV-411.
Please help us improve our service by completing a one-minute customer satisfaction survey. Your responses are completely
confidential. Visit http://www.in.gov/bmvsurvey/start and enter the survey code 192397773 to get started. Thank you.
IIIIIDIIIIIVIIIVIIIIII
11111111111111111111111111111111111111111111111 Page 1 of 1I
5 1 7 1 7 2 3 4 0 1 9 1 8 8
State Form 48099(R2/11-10)
Approved by State Board of INDIANA CERTIFICATE OF VEHICLE REGISTRATION
Accounts 2010
CLASS AGE JISSUE DATE PUR DATE COUNTY TP PL YR PLATE PL TP WEIGHT PR YR LS TYPE
04/17/2014 03/18/2014 29-HAMILTON N 2013 1 MO N
EXPIRATION DATE PRIOR PLATE VEHICLE YEAR MAKE TYPE MODEL COLOR VEHICLE IDENTIFICATION NUMBER
NO EXP 2014 FOR TK F2S WHI/ 1FT7X2663EEB80737
CURRENT EX TAX EX CREDIT DAV CREDIT EX TAX DUE WHEEUSUR STATE REG FEE ADMIN FEE TOTAL DUE
YEAR TAX 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
PRIOR EX TAX EX CREDIT DAV CREDIT EX TAX DUE WHEEUSUR STATE REG FEE ADMIN FEE TOTAL DUE
YEAR TAX 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CITY OF CARMEL FIRE DEPT N
2 CIVIC SQ LB
CARMEL,IN 460322584
IMPORTANT REGISTRATION INFORMATION
The registrant acknowledges that the information provided on the front of this
form is correct. The registrant understands that proof of financial
responsibility(insurance)for this vehicle will be continuously maintained
during the registration period. Additional taxes and/or fees may be due if an
error or an adjustment to the amount due is made.
I
CUSTOMER COPY
APPLICATION FOR CERTIFICATE OF TITLE - STATE OF INDIANA - BUREAU OF MOTOR VEHICLES
State Form 205(R7/6-04) Approved by State Board of Account 1997
TO BE COMPLETED BY A POLICE OFFICER,BMV OFFICIAL OR BMV CERTIFIED DEALER SIGNEE I/WE THE UNDERSIGNED SWEAR OR AFFIRM THAT THE INFORMA-
FOR OUT OF STATE TITLES.I HEREBY CERTIFY THAT I PERSONALLY EXAMINED THE FOLLOWING TION ENTERED ON THIS FORM IS CORRECT. I/WEUNDERSTAND
VEHICLE AND FIND THE IDENTIFICATION NUMBER TO BE AS FOLLOWS THAT MAKING A FALSE STATEMENT ON THIS FORM MAY CONSTI-
VEHICLE IDENTIFICATION NUMBER TUTE THE CRIME OF PERJURY. FUTHERMORE,I/WE AGREE TO
INDEMNIFY AND HOLD HARMLESS THE INDIANA BMV FROM ANY
LIABILITY ARISING FROM THIS TRANSACTION.
R MAKE MODEL TYPE DATE X
X
INSPECTOR'S PRINTED NAME&TITLE CITY
DATE:
The law requires that you apply for Certificate of Title within thirty-one days from the date of purchase of a
INSPECTOR'S SIGNATURE motor vehicle.There is a delinquent fee of$21.00 for failure to do so.Attach Certificate of Title assigned by seller.On ea-
DEALER PLATE NO. domed Titles,liens must be released.Supporting documents surrendered with this application cannot be returned to the apply
cant State fee for applying for Title is51s.0o.*In accordance with Federal Code383.
TITLE NUMBER BRANCH NO INVOICE NO BMV USE ONLY
1. 04171480300116 803 MV-GOVERNMENT-CERTIFICATE OF ORIGIN
'SOC.SEC./FEDERAL I.D.NO APPLICANT'S NAME BMV USE ONLY D
2. CITY OF CARMEL O
STREET ADDRESS CITY STATE ZIP CODE N
3. ONE CIVIC SQUARE CARMEL IN 46032 0
T
VEHICLE I.D.NUMBER VEH.YEAR VEH.MAKE VEH.MODEL NO. VEH.TYPE ODOMETER ACTUAL
4. 1FT7X2B63EEB80737 2014 FOR F2S TK 35 M T
FORMER TITLE NUMBER [PURCHASEDATE LIEN SPEED PICK UP MAIL DEALER NO. BMV USE ONLY Y
P
3. C-OF O 03/18/2014 5 No No Yes E - _--"
FIRST LIEN'S NAME OR SPECIAL MAILING ADDRESS STREET ADDRESS
6. CITY OF CARMEL 1 CIVIC SQ N
CITY STATE ZIP CODE BMV USE ONLY
7 CARMEL IN 46032-2584 T
H
SECOND LIEN'S NAME STREET ADDRESS I
8. S
CITY STATE ZIP CODE LICENS9 NUMBER LIYEEANRE FORMS BMV USE ONLY A
9 USED LB R
GROSS RETAIL&USE TAX AFFIDAVIT-IM/E HEREBY CERTIFY THAT SALES OR USE TAX ON THIS VEHICLE WAS PAID AS INDICATED BELOW E
A
SELLING PRICE LESS TRADE-IN / DISCM UNT
OUNT AUBJECT TO TAAMOUNT OF TAX DEALER BRANCH EXEMPT IF EXEMPT
10. $ 0.00 0.00 0.00 $ 0.00 $ X PLACE 1 ARA.#
Your Social Security number/Federal I.D.number is being requested by this agency under 1134-11-8-1. Disclosure is mandatory and this document cannot be processed without it.
APPLICANT RESPONSIBLE FOR ACCURACY OF INFORMATION
APPLICATION FOR CERTIFICATE OF TITLE - STATE OF INDIANA - BUREAU OF MOTOR VEHICLES
II VIIIIIIDIII IIIIIIIVIIIILIIIIIIIVIIINIIIVIIIVIIIIII
2 0 5 2 3 4 0 1 9 0 0 9
CUSTOMER COPY
Bureau of Motor Vehicles II�IIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIII�IIII
^k Customer Detailed Transaction Receipt
State Form 51714 (4-04)
Branch: VEHICLE SERVICES- REGISTRATIONS Date: 04/17/2014 Time: 14:42 EDT
x'19
Visit ID: 97773 CSR: LB
Visit Customer: CITY OF CARMEL FIRE DEPT
Transactions
Trans ID Trans Tvpe Trans Subtype Amount
234019009 Title - Initial Title Issuance New
Title Fee -Vehicle $15.00
Vehicle: 1 FT7X2663EEB80737 2014 FOR F2S 4C
Lien Holder: None
Customer: CITY OF CARMEL
Purchase Date: 03/18/2014
$15.00
Charges to your credit card will appear as a line item charge not as a total transaction charge. Page 1 of 1
Bureau of Motor Vehicles
Customer Registration Fees Detailed Receipt
R.B44V State Form 51718 (4-04)
Branch: (VgE�HIICLE SERVICES- REGISTRATIONS Date: 04/17/2014 Time: 14:34 EDT
Visit ID: '1 JZ397773 Tran ID: 234019188
Visit Customer: CITY OF CARMEL FIRE DEPT STARS Trans#: 04171480300021
Transaction Type: New Motor Vehicle Registration
Registration License Type: MUNICIPAL OWNED
Plate\Permit\Registration Number:
Vehicle Identification-Number: 1 FT7X2B63EEB80737
Vehicle Year: 2014
Vehicle Make: FORD
Vehicle Model: F250 SUPER DUTY
Registration Year Fee Type Subtotal Total
2014
Total for 2014:
2013
NONE (NONE) 2013 $0.00
CITY OF CARMEL FIRE DEPT
Total NONE(NONE) 2013: $0.00
Total for 2013: 0.00
Transaction Total: 0.00
Charges to your credit card will appear as a line item charge not as a total transaction charge. Page 1 of 1
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))
New Truck $15.00
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 NO. WARRANT NO.
ALLOWED 20
Gary Carter
IN SUM OF $
$15.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 43-583.00 $15.00 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 APR
2 a 9A9R
i 1 P-=
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund