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232241 05/07/14 v/ \ CITY OF CARMEL, INDIANA VENDOR: 368174 ;; ® ONE CIVIC SQUARE IAFC-EXPERIENT CHECK AMOUNT: $*******435.00* 4,. =a; CARMEL, INDIANA 46032 PO BDx 4088 CHECK NUMBER: 232241 �bp�oN FREDERICK MD 21705 CHECK DATE: 05/07/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4357004 24586 435.00 REGISTRATION FEES • Powered by the lAFC �zo14 U Response Teams Conference Complete one form per registrant. Name IAFC Member Number Title Rank(Please choose one from the list of options below.): J Fire Chief J Chief Officer J Company Officer J tall Officer firefighter J Firefighter/Paramedic J EMS Officer J Emergency Management technician J Other /716 / 06i�fl J '9 l Organilat (Is this addess:JNome ODepartment) 0o City StateZi Country Phone Fax E-mail(Please complete to receive your confirmation and conference updates.) 1 , CONFERENCE REGISTRATION On or Berore 5/1/14 After 511!14 IAFC Member C3$360 C3$395 Non IAFC Member ;J$395 .2"$435 One-day registration Q$180 t_j$240 Total Registration Due(in U.S.Dollars):$ 1-1 IS 5 To help us better serve you,please answer the following: 4.Number of Members in your Department 1.Are you 7 10-50 7 51-100 101-400 7 volunteer career 7 401-1000 7 1,000 and over 2.Type of department 5.What is your purchasing responsibility? 7 volunteer ,�career O combination 7 tribal O final decision maker 7 significant influence 7 airport 0 industrial 7 military 7 other /1,thir ecommend 7 research/specify 3.Size of population served your first time attending the conference? .00 7 0-9,999 ❑10,000-49,999 [3500-99,999 7 Yes yQ No,I have attended for the past years. 1:1100,000-199,999 O 200,000 and up trrchase Order q�y5�� (Copy of PO or form must be provided to process registration.) r cZ� p O Check Enclosed(Please make checks payable to"[AFC,in U.S.funds.) S J C)Credit Card 7 AMEX 13 VISA 7 MasterCard 7 Discover Card R(with CSV code) Expiration Date(Must be after 6114) Name as it appears on card Signature 5 1 1 . Online:www.iafc.org/HAZMAT Mail:IAF[c/o Experient,Inc.,P.O.Box 4088,Frederick,MD 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 HAZMAT@experient-inc.com or auxiliary aids,please notify us of your needs in advance by calling 866.289-2386. Snyder, Denise W From: Event Customer Service <email_confirm@confmail.experient-inc.com> Sent: Thursday, May 01, 2014 09:34 To: Anderson, Cory D Cc: Snyder, Denise W Subject: International Hazardous Materials Response Teams Conference 2014 Confirmation {HAZ141:1986) May 29-June 1 PbwoedbytheuFC 2 ,4 2014 .y e Response Teams Conference Baltimore.Mill �- Confirmation ID: 1986 Cory Anderson Carmel Fire Dept 2 Civic Square Carmel, IN 46032 ---Balance due-please resolve to avoid cancellation--- Dear Cory Anderson: Thank you for registering for the International Hazardous Materials Response Teams Conference to be held Thursday, May 28-Sunday,June 1,2014, in Baltimore, Maryland. Your badge,as well as other pertinent information,will be available at the Hazmat Conference registration desk at the Hilton Baltimore. Hotel Accommodations: Hilton Baltimore 401 W. Pratt Street Baltimore, MD 21201 Phone:443.573.8700 Website: Hilton Baltimore(http://www.hilton.com/en/hi/groups/personalized/B/BWICCHH-IAF- 20130602/indexjhtml?WT.mc id=POG) Please request the International Association of Fire Chiefs Hazmat group rate when making your reservation.All reservations must be made by April 30.After this time, reservations are based on availability and current rate. Hotel Rates:$145 PER NIGHT(SINGLE/DOUBLE) Registrant Badge Information: Cory Anderson Carmel Fire Dept Carmel , IN 1 Registration Detail Purchases for Cory Anderson-This registrant has a balance due Re istration Type: HAZC-Conference, Onsite -Item Description Date/Time Qty. Item Price Item Totalj Code REG Registration 1 $435.00 $435.00 Total Registration Fees: $435.00 Total Registration Paid: $0.00 Current Balance: $435.00 Total of All Fees: $435.00 Total Amount Applied to All Fees: $0.00 Total Balance Due: $435.00 Cancellation Policy All cancellations will be subject to a$75 administrative fee. Cancellations must be sent in writing to the Hazmat Registration Center via fax or email.Telephone cancellations will not be accepted. All Cancellations must be received in writing by April 30,2014. No refunds will be issued after this date. After April 30,2014,substitutions will be allowed in the event the registrant is unable to attend, but no refunds will be issued.Telephone substitutions will be permitted. You may also make changes via e-mail to customer service or by calling (866)229-2386 or(301)694-5243. For more Show Information, please visit www.iafc.org/hazmat 2 VOUCHER NO. WARRANT NO. ALLOWED 20 IAFC- C/O Experient, Inc. , IN SUM OF$ PO Box 4088 I Frederick, MD 21705 A $435.00 ) I + ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 24586 43-570.04 $435.00 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 MAY - 5 2014 1 , Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) $435.00 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