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Home My WebLink About239896 12/09/14 W.C.Ig3f CITY OF CARMEL, INDIANA VENDOR: 364188 ® it ONE CIVIC SQUARE AMERICAN PUBLIC WORKS ASSOCIATI®NECK AMOUNT: S********87.00* CARMEL, INDIANA 46032 PO BOX 802296 CHECK NUMBER: 239896 9`�r�N.�:r KANSAS CITY MO 64180-2296 CHECK DATE: 12/09/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2200 4355300 87.00 ORGANIZATION & MEMBER Individual or Group? Decide which type of membership works best for you, individual or group.APWA offers a number of membership categories based on your organization's strategic interests and objectives. Descriptions of each type of membership may be found at www.apwa.net/membership. (Live/work in Canada?Please use the CPWA Application instead of this one.) Questions? Contact a membership specialist at 800-848-APWA or memberservices@apwa.net. INDIVIDUAL MEMBERSHIP=(Choose either individual or group,merrtbership,then go to Step 2) Individual membership is available to any official or employee of a governmental agency,manufacturer,supplier,contractor,or consulting firm enter total that is actively engaged in the field of public works.Visit www.apwa.net/membership for benefits chart. Student membership also available,more information at www.apwa.net/Membership/Types-of-Membership. Individual Membership$174 USD each X Total number of members 1 = s $"4 "= For information about L--7 using the half-price.offer — OR to start a new group or add members to an existing group, call 800-848-2792,omai . 1 memberservicesgapwa GROUP MEMBERSHIP.(Choose one of the three types of,group membership,then gotoStep 2) Groups will receive one consolidated renewal notice with a member roster attached.Public Agency,Corporate,and One-Call groups may add or drop members from the roster throughout the year,if necessary.Additional members can be added for$146 USD each. Use the Member Information section in Step 5 to provide names and contact information for people to be on the group roster. PUBLIC AGENCY GROUP MEMBERSHIP enter total Available to any federal,provincial,state,local or other public agency concerned with public works.The number of individual memberships and the annual fee for an agency are based on the population served by the agency.When joining as an agency,each member saves$28 USD on annual membership dues.Visit www.apwa.net/membership for benefits chart.Select the appropriate population category for your type of agency. Use the'Additional Rostered Members"line below if you would like to have more than the specified number of rostered members for that population category ($146 USD per additional person). •State Agencies—Number of rostered members and annual dues for the group would be determined using the"Population Served"column representing 10%of total state population. • County Agencies—Number of rostered members and annual dues for the group would be determined using the"Population Served"column representing 50%of total county population. •Special Districts—Number of rostered members and annual dues for the group would be determined using the"Population Served"column representing 20%of total district population. •All others—Refer to column representing total population served by the agency. Population Served 0– 10,001 – 25,001 – 50,001 – 100,001 – 300,001 – 500,001 – More than Federal 10,000 25,000 50,000 100,000 300,000 500,000 1,000,000 1,000,000 A enc Number of Rostered 2 4 6 10 16 20 26 30 50 Members Covered* Annual Dues(USD) 5292 $584 $876 51460 $2336 $2920 $3796 $4380 $7300 s CORPORATE GROUP MEMBERSHIP enter total Available to any non-governmental entity that furnishes public works services or products,including privately held or incorporated utilities.Select a level of corporate membership:Heritage,Prestige,or Crown.Visit www.apwa.net/membership for benefits chart.Use the'Additional Rostered Members'line below if you would like to have more than the specified number of rostered members for the corporate group type you choose(5 146 USD per additional person). Membership Level Heritage Prestige Crown Number of Rostered Members Covered 2 10 40 Annual Dues(USD) 5427 51785 58478 s ONE-CALL CENTER/SYSTEM GROUP MEMBERSHIP enter total Provides a method for those focused on damage prevention to share new technologies and practices and to promote public safety.Covers two rostered members.Use the'Additional Rostered Members"line below if you would like to have more rostered members(5146 USD per additional person). One-Call Group Membership$336 USD $ ADDITIONAL ROSTERED MEMBERS 5146 USD each X Total number of additional members = s enter total Student memberships are available;visit www.apwa.net/membership for details. TOTAL Fee schedule through December 31,2014. s Optional Memberships ❑ ' OPTIONAL MEMBERSHIPS (select any optional memberships,then go,to Step 3). Please complete this section if you would also like to join PUBLIC WORKS HISTORICAL SOCIETY(PWHS)and note in Step 5 to which person this enter total membership should apply. PUBLIC WORKS HISTORICAL SOCIETY(PWHS)is dedicated to improving the public's awareness and appreciation of public works throughout history. $35 USD X Total number of members $ Local Chapter Dues There are 55 APWA chapters in the United States, and 24 have local chapter dues in addition to national membership dues.The national headquarters handles the collection of those local chapter dues,which (where applicable) are mandatory and must be paid in full to maintain active membership status. For a complete list of chapters visit www.apwa.net/chapters. ❑ LOCAL CHAPTER DUES (Note local chapter dues�if applicable-then-go to Step 4) Arizona $20 per person Minnesota 25%of full price enter total National dues Arkansas 25%of full price National dues Nevada S10 per person Northern California25%of full price (counties of San Francisco,Alameda,Contra Costa,Marm,Sola no,Napa, 510 per person National dues NeW England(CT MA,NH,RI,VT) Sonoma,Lake,Mendocino,Humboldt,and Del Norte,plus northern San Mateo county) New Jersey S15 per person Sacramento Area,California New York S15 per person (counties of Siskiyou,Modoc,Trinity,Shasta,Lassen,Tehama,Plumas,Glenn, S1 D per person (e (udmg NY City metro area) Butte,Colusa,Sutter,Yuba,Nevada,Siena,Yolo,Sacramento,Placer,EI North Carolina 510 per person Dorado,Amadore,Calaveras,Tuolumne,Mono,Alpine,and San Joaquin) San Diego/Imperial Counties,California S25 per person Ohio S15 per person Southern California 25%of full price Rocky Mountain(ID,MT,WY) S10 per person (counties of Los Angeles,Orange,San Bernardino,and Riverside) National dues Tennessee 515 per person Ventura County,California 510 per person Texas 510 per person Chicago Metro,Illinois Utah 515 per person (counties of Cook,DeKalb,DuPage,Grundy,Kane,Kankakee,Kendall,Lake, 51 5 per person McHenry,and Will) Washington 520 per person Kentucky S20 per person Wisconsin S15 per person Michigan S25 per person Mid-Atlantic(DC,MR VA,WV) S10 per person X Total number of members = $ Payment (Complete payment information then go to Step 5) Send entire completed application and payment information. Membership From Step 1:Enter Individual or Group Membership Dues Total $ is for one year and will begin upon receipt of dues payment.Purchase orders are acceptable, but members will not receive benefits until receipt From Step 2:Enter Optional Membership Dues Total $ of payment. APWA membership dues are not deductible as a charitable contribution but may be deductible as an From Step 3:Enter Local Chapter Dues Total(if applicable) $ _ ordinary business expense,subject to IRS limits.APWA does not designate the use of membership dues V for lobbying or advocacy efforts;however,nine percent(9%)of our total operating budget is allocated T.O 'AL PAY ENT`DUE toward advocacy-related programs,including staff salaries.Please consult your tax professional with regard to eligible ordinary business expenses. ",.. J Check enclosed for ❑ Charge S to my U Visa ❑ Mastercard ❑ American Express �Jl Please mail an invoice When paying by credit card,dues are charged in US dollars and may be subject to the exchange rate at the time to the attention of: $ the payment is processed. IN USA, MAIL TO:APWA, — PO Box 802296,Kansas City, Account number Card Expires(MM/YYYY) MO 64180-2296 LIVE/WORK IN CANADA? Name as it appears on card Signature MAIL THIS REQUEST TO: APWA,2345 Grand Blvd., Please use the CPWA Would you like a receipt sent to you. ❑ Yes ❑ No Suite 700,Kansas City, application at: MAIL TO:APWA,2345 Grand Blvd.,Suite 700,Kansas City,MO 64108-2625 MO 64108-2625 www2.apwa.net/ Documents/Membership/ OR FAX TO:816-303-4950 or 816-472-1610 OR FAX TO: MemApp_CAN.pdf OR ONLINE:www.apwa.net/membership 816-303-4950 Sponsored by: Member Information (Please print) (optional) Date: •Alternate address and contact information becomes useful when members make career changes. Please mark whether you prefer to receive mail at home or office address. • E-mail addresses are only utilized for distributing APWA-related news and information. • For group memberships including more than 3 individuals, please copy this form as needed. • For group membership,please identify to whom the group's annual membership renewal invoice should be addressed. Mr, Jeremy TV). iKcisl-,mcLn ►q 80 Mr.,Mrs.,Ms.,etc First Name MI Last Name(include suffix) Preferred Name(informal) Year of Birth 01 -y oC CC-t-rr-ine� De�ar+�r�ent Cod C'ri--( Eng; ,mer Organization(Agency/Firm) Department/Division �n�: E,e�r rt Title C%v� G sCVItC1re— Office Address C CL•—mE.l IN 4(0 032 I I S city State Zip+4 Code Country L3 k--V) S-q 1 — -2- 1 .)kI,-jmcL'1 @ c ctr-m ei- rn. Office Phone Office Fax Office E-mail Alternate Address(optional) Preferred Mailing Address: �1 Office ❑ Alternate Alternate Phone(optional) Alternate E-mail(optional) Mr.,Mrs.,Ms.,etc First Name MI Last Name(include suffix) Preferred Name(informal) Year of Birth Organization(Agency/Firm) Department/Division Title Office Address City State Zip+4 Code Country Office Phone Office Fax Office E-mail Alternate Address(optional) Preferred Mailing Address: ❑ Office ❑ Alternate ` Alternate Phone(optional) Alternate E-mail(optional) Mr.,Mrs.,Ms.,etc First Name MI Last Name(include suffix) Preferred Name(informal) Year of Birth Organization(Agency/Firm) Department/Division Title Office Address City _State Zip+4 Code Country Office Phone Office Fax Office E-mail Alternate Address(optional) Preferred Mailing Address: ❑ Office ❑ Alternate Alternate Phone(optional) Alternate E-mail(optional) The American Public Works Association recognizes,appreciates,and fosters the synergy which is created when the work environment values the differences in individuals and practices inclusiveness and open communication. 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 American Public Works Association Purchase Order No. PO Box 802296 Terms Kansas City, MO 64180-2296 Date Due Invoice Invoice Description Date Number (or note attached invoice(s)or bill(s) Amount 121812014 0 New APWA membership for Jeremy Kashman $ 87.00 f Total $ 87.00 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. American Public Works Association ALLOWED 20 PO Box 802296 IN SUM OF $ Kansas City, MO 64180-2296 $ 87.00 ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#(TITLE AMOUNT DEPT# I hereby certify that the attached invoice(s), or 0 0 2200-4355300 $ 87.00 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 12/8/2014 Signature City Engineer Cost Distribution ledger classification if Title claim paid motor vehicle highway fund