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Home My WebLink About240216 12/16/14 CITY OF CARMEL, INDIANA VENDOR: 013514 ® ONE CIVIC SQUARE APCO INTERNATIONAL, INC CHECK AMOUNT: $********92.00* =a CARMEL, INDIANA 46032 351 N WILLIAMSON BLVD CHECK NUMBER: 240216 DAYTONA BEACH FL 32114-1112 CHECK DATE: 12/16/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1115 4355300 92.00 ORGANIZATION & MEMBER ANNUAL DUES INVOICE Federal ID Number 63-046-1885 APCO�i International 351 N INTERNATIONAL INC. 351 NORTH WILLAMSON BLVD. DAYTONA BEACH,FLORIDA 32114 APCO International♦351 North Williamson Blvd.♦Daytona Beach,Fl-32114 888-APC09-1-1 OR 386-322-2500 Janet Arnone Statement Date: 12/5/2014 Office Administrator Carmel Clay Communications Center P.O.Number: 31 1St Ave NW Carmel,IN 46032-1715 Bill Code: 308659 Total Amount Due: $92.00 You are being billed for:2015 APCO Membership Dues Note: •Return invoice with remittance. •Please indicate those individuals no longer with your organization by drawing a line through their name. •Each new member requires a new application. Please complete the application on the back. Duplicate application as needed. Payment: Donations: ❑ Check Check: Silent Key: ❑ MasterCard Card#: $ ❑ Visa Expiration Date: Sunshine Fund: ❑ Amex Cardholder's Name: $ ❑ Discover Cardholder's Signature: Please add this to your total amount due. Please retain a copy for your records and mail invoice with payment. MBR# CAT. NAME DESCRIPTION AMOUNT DUE Primary Chapter Original Amt Amount Due AmountPaid Balance 96115 FULL Todd Luckoski 0 IN $92.00 $92.00 $0.00 $92.00 - otalAmount ue: $92-60 Page 1 of 1 Public Safety Practitioner MEMBERSHPAPPUCATMN Commercial members use application at:www.apcointi.org/commercial-application NAME TITLE PRIMARY CONTACT(group membership only) ORGANIZATION AMATEUR CALL SIGN ORGANIZATION ADDRESS CITY STATE ZIP EMAIL PHONE FAX HOMEADDRESS CITY STATE ZIP PRIMARYADDRESS: ❑ HOME ❑ WORK REFERRED BY FUTURE INVOICES: ❑ BILL ME DIRECTLY ❑ ADD TO AGENCY BILL CODE MEMBLR`Pe a — -o -- ---- -- _ =� – ❑ Full Member:Tier One—$92 USD Agency Category—Please select one that best fits: Individuals who are employed by or retired from a ❑ Consolidation Dispatch ❑ Fire Department government entity or a contractor of a government Center ❑ Law Enforcement ! entity and are responsible for the management, ❑ Emergency Management ❑ PSAP design,construction,installation,command, ❑ EMS ❑ Other and operation of public safety communications ❑ Government Agency systems and supporting information systems. ❑ Police Includes voting privileges. Job Classification—Please select one that best fits: ❑ Full Member:Tier Two—$120 USD ❑ 9-1-1 Coordinator ❑ Sheriff Applicants as defined above in Tier One residing ❑ Emergency Management ❑ Supervisor ❑ Engineer/Technician ❑ Telecommunicator in California,Louisiana and Oregon are to select ❑ Information Systems /Dispatcher this Tier.(Note:Tier selection/membership dues ❑ Manager ❑ Training&Education are set by each respective Chapter.) ❑ Police Chief Coordinator ❑ Associate Member—$69 USD ❑ Other Individuals who perform non-administrative and/ - R MAT e 1 or non-supervisory functions within their agency. I Associate members do not have voting privileges. ❑ Check enclosed# ❑AMEX ❑MASTERCARD ❑ DISCOVER ❑VISA ❑ Additional Chapters: CARD NUMBER Persons residing and/or permanently employed in the chartered area of a Chapter are required to EXPIRATION DATE SECURITY CODE be members of such chartered Chapter.Members SIGNATURE belonging to one Chapter may become a member j PRINTNAME - -- of any other number of Chapters.Please list the j additional Chapters by name: CARDHOLDER'S EMAIL ' Mail completed application with payment to: APCO International Membership Additional Tier 1 Chapters x$18.40 351 North Williamson Blvd.,Daytona Beach,FL 32114 Additional Tier 2 Chapters x$46.40 or Fax to 386.944.2729 or email to membership@apcointl.org Total Due Your membership will be activated upon full payment q06UPFAEMREhSHIF1of applicable dues. y Membership Levels Tier 1 Tier 2 (CA,LA,OR) *Note:$35 of your membership goes to your subscription to Public I Safety Communications.APCO International annual dues are ' ❑ Level One ❑ $331 ❑ $413 .nota deductible contribution for federal tax purposes,but may be (Up to 10 staff) deducted as a business expense.Public Safety Communications ❑ Level Two ❑ $856 ❑ $1,080 subscription price for one year is included in membership dues (11 to 25 staff) and members may not deduct the subscription price from dues. ❑ Level Three ❑ $1,575 ❑ $1,995 APCO estimates that an additional 3%of your dues are not (26 to 50 staff) deductible because of APCO's lobbying activities on runs through ❑ Level Four ❑ $2,304 ❑ $2,920 the calendar year.See website for proration information. (51 staff and above) VOUCHER NO. WARRANT NO. APCO International ALLOWED 20 IN SUM OF $ 351 N. Williamson Blvd. Daytona Beach, FL 32114 $92.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Clay Communications PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1115 I I 43-553.00 I $92.00 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 Friday, December 12, 2014 Diect r 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)) 12/05/14 $92.00 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