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HomeMy WebLinkAbout234890 07/16/14 CITY OF CARMEL, INDIANA VENDOR: 363105 ij ONE CIVIC SQUARE INTL POLICE MOUNTAIN BIKE ASSOC CHECK AMOUNT: $********70.00* CARMEL, INDIANA 46032 583 FREDERICK ROAD SUITE 5B CHECK NUMBER: 234890 BALTIMORE MD 21228 CHECK DATE: 07/16/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4355300 70.00 ORGANIZATION & MEMBER IPMBA MEMBERSHIP AND CERTIFICATION APPLICATION nun"W" IPMBAMembershipand Certificationyour liability and helps DQ° giF� .oc u. 1 / / PUBLIC SAWFY •� Cvcu"r. BENEFITS INCLUDE: • Internationally recognized IPMBA Police,EMS or Security Cyclist Certificate... • IPMBA News(training tips,product reviews,funding information,and resources)... IPMBA • Subscription to Bicycling*Magazine... • Discounted registration to 1PMBA's Annual Conference... • Access to advanced training opportunities,including the IPMBA Instructor Course... • Members-only discounts on equipment and gear... • IPMBA member decals! (*A$10.00 value,U.S.addresses only.) Name D.J.Schoeff Police m EMS O Security l7 IPMBA certification is available Home Address 10138 N.Park Ave. to members only. City Indianapolis State IN Zip/Country 46280 IPMBA membership is open to 317 697-9502 individuals only. Home Phone( ) Mobile( ) Membership materials will be Personal E-Mail Address d_schoeff@yahoo.com mailed to your home address. Department E-Mail Address dschoeff@carmel.in.gov (Allow 6-8 weeks) Department Carmel Police Department Please mail applications and Department Address 3 Civic Square payment immediately following City Carmel StateIN Zip/Country 46032 the course. Dept.Phone( 317 ) 571-2500 Dept.Fax ( ) Membership Number(for current IPMBA members) Mail form to: I have successfully completed the following IPMBA Course(check one),scoring at IPMBA least 76%on the written test and passing the practical skills tests. 583 Frederick Rd. ®Police Cyclist Course 13 EMS Cyclist Course l7 Security Cyclist Course Suite 5B Baltimore MD Primary IPMBA Instructor's Name: 21228 Instructor Number. Dates of the Course: Month Dates Year -or- Location of Course: Fax credit card info to: (Facility Name,City,and State) 410-744-5504 I would like to become an IPMBA-Certified PAYMENT METHOD(U.S.FUNDS ONLY) Police, EMS, or Security Cyclist and join 13 Check or money order(payable to IPMBA) IPMBA's Registry of Certified Public Safety - p visa O MasterCard (select one) Cyclists. Name on Credit Card(please print): El $70.00 IPMBA Certification(includes Email Address of Card Holder: one year of membership) Credit Card Number: ❑ $ 5.00 Police Cyclist Pin(❑gold or❑silver) Expiration: / Code: ❑ $ 5.00 EMS Cyclist Pin(gold only) Signature: ❑ $ 5.00 Security Cyclist Pin(silver Billing Address: O Home O Department Only) $ TOTAL Purchase orders accepted for multiple memberships only. Federal Tax ID:52-2137781 ©2012 International Police Mountain Bike Association•www.ipmba.org Reset Form l VOUCHER NO. WARRANT NO. ALLOWED 20 International Police Mountain Bike Association IN SUM OF$ 583 Frederick Road, Suite 5B Baltimore, MD 21228 $70.00 i ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 43-553.00 $70.00 I 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 Thursday, July 03, 2014 i Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund i 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)) 07/03/14 annual membership $70.00 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