241965 2 /10/2015 (9,
CITY OF CARMEL, INDIANA VENDOR: 367119
ONE CIVIC SQUARE EVERGREEN MOUNTAIN, LLC CHECKAMOUNT: $"`"'1,648.00;CARMEL, INDIANA 46032 PO Box 1169 CHECK NUMBER: 241965
TAOS NM 87571-1169 CHECK DATE: 02/10/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210. 4357000 32756 151 1,648.00 SNIPER TRAINING
- EGM
INVOICE
EVEEi(3RF'F'ry molni'Jak i LLC
DATE: February 3,2015
Evergreen Mountain, LLC
PO Box 1169
Taos NM,87571-1169 INVOICE# 151
Phone(910)635-2217
FOR: Sniper Training
BILL TO:
CARMEL POLICE DEPARTMENT
THREE CIVIC SQUARE
CARMEL INDIANA 46032
317-571-2500
DESGRIPTIOW, #:of STUDENTS,.. CRATE per"Student #DAYS of TRAINING:', AMOUNT
SNIPER TRAINING 2 $206 4
TRAINING LOCATION: FT WAYNE, IN
TRAINING DATES:15-18 MAY 2015
OFFICERS ATTENDING:DffiVENPORT&
VANNATTER
SUBTOTAL
TAX RATE 0.00%
SALES TAX
OTHER -
TOTAL
Make all checks payable to Evergreen Mountain,LLC
THANK YOU FOR YOUR BUSINESSI
\3 \L?
EGM
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Evergreen Mountain,LLC COURSE REGISTRTI®N
NAME RANK/ASSIGNMENT/TITLEA�vi �� po �. )(I'ATIOM
aw Enforcement OMilitary0Other
PREFERREDADDRESS j CITY STATE I ZIP CODE
. L,,q�r✓v�-e
PREFERRED TELEPHONE NUMBER PREFERRED E-MAIL ADDRESS
------ -----------_. _._.._.__ ._..------ f
AGENCY/BASE DDRESS CITY - _ -- ----- STATE ZIP CODE
elmwet 1, e ( 3 �'z,G
AGENCY/BASE TELEPHONE NUMBER O(TENSION AGENCY/BASE E-MAIL ADDRESS
217-S-7/- ;23-W 0
Evergreen Mountain,LLC requires all non-DOD or Law Enforcement personnel to submit appropriate/D;
Aixurrent drivers license OR ❑ Passport OR ❑ Any current ID that proves US citizenship
COURSEISEMINAR SELECTION: Price is per student
❑Basic Night Vision Course(3 Day)($600) ❑ Instructor Shoothouse(3 Day)($600)
❑Principles of Urban Conflict(3 Day)($600)(4 Day)($800) ❑Carbine/Pistol Course($zoo/day)
❑Rural Area Small Unit Tactics zoo da )6_Sniper Course zoo da
❑Tactical Team Leader Course(5 Day)($i,000) ❑ Leadership Seminar($85)
Q COURSE LOCATION COURSE DATE(S)
By signing and submitting this registration form,l understand and agree to the following:
-That the credentials included with this registration form meet the requirements as specified by Evergreen Mountain,LLC,and °
that I will be required to show proof of identification on the first day of the course/seminar.
-Where applicable,that Evergreen Mountain, LLC courses will depend upon the careful control of deadly weapon(s)by me,
therefore, I understand and agree that my participation may be terminated at any time during the course if the staff/
instructor deems my behavior,conduct or weapon handling skills to be unsatisfactory.
That I will abide meticulously by any and all safety procedures as outlined and specified by Evergreen Mountain,LLC and that I
L
e to signing a liability waiver form releasing Evergreen Mountain,LLC from any injury I may sustain during the course.
tand that my deposit is non-refundable and non-transferable. However,in the case of an emergency,I understand
rgreen untain,LL ork to provide a fair and equitable solution for both parties.
DATE
I 2 12 /2ot5
If paying by credit card,please complete the following. ❑ DrWc Xvw ❑ t( ❑ VISA
LTJ ,,
NAME AS IT APPEARS ON CREDIT CARD 'AUTHORIZATION SIGNATURE I DATE
CREDIT CARD NUMBER 1 EXPIRATION DATE 3 DIGIT AUTHORIZATION CODE
IMPORTANT: Your credit card will be charged the day your registration form is received. Please include the bill-
ing address where the monthly statement is sent.
ADDRESS CRY STATE I ZIP CODE
I
PLEASE MAKE
i
CHECK/MONEY •'I TO: MOUNTAIN,
SCAN I EMAIL REGISTRATION •• i COPY OF / •N TO:,ROB@EVERGREENMOUNTAINUSA.COM
MOUNTAIN,OR MAIL REGISTRATION FORM1 COPY OF IDENTIFICATION,AND PAYMENT TO:
EVERGREEN LLC • . Box 116,9 A • i • •
S
5
EGM C4*,
OA
Evergreen Mountain,LLC
g COURSE REGISTRTiON
eoo,�� OCC UPATION RAN
RSSIGNMENT/TIRE
(/��rJ�/YY' 2- OLawEnforcement OMilitary00ther /A
PREFERRED ADDRESS - CITY - STATE ;ZIP CODE
0 i �
PREFERRED TELEPHONE NUMBER PREFERRED E-MAIL ADDRESS
6-,g
AGENCY/BASE ADDRESS CITY STA - ..1 ZIP CODE_ _
AGENCY/BASE TELEPHONE NUMBER EXTENSION AGENCY/BASE E-MAIL ADDRESS
$Ev rgreen Mountain,LLC requires all non-DOD or Law Enforcement personnel to submit appropriate/D
ent drivers license OR ❑ Passport OR ❑ Any current ID that proves US citizenship
COURSE/SEMINAR SELECTION: Price is per student
❑Basic Night Vision Course(3 D6y)($600) ❑ Instructor ShoothouseDa
(3 Y)($boo)
❑Principles of Urban Conflict(3 Day)($600)(4 Day)($800) ❑Carbine/Pistol Course($zoo/day)
❑Rural Area Small Unit Tactics $zoo/da er Course zoo da
° ❑Tactical Team Leader Course(5 Day)($t,000) ❑ Leadership Seminar($85)
COURSE LOCATION COURSE DATE )
y .mow it P1
yVsp
By signing and submitting this registration fonn,I understand and agree to the following:
-That the credentials included with this registration form meet the requirements as specified by Evergreen Mountain,LLr'and
that I will be required to show proof of identification on the first day of the course/seminar.
-Where applicable,that Evergreen Mountain, LLC courses will depend upon the careful control of deadly weapon(s)by me;
therefore, I understand and agree that my participation may be terminated at any time during the course if the staff/
instructor deems my behavior,conduct or weapon handlingskills to be unsatisfactory.
-That I will abide meticulously by any and all safety procedures as outlined and specified by Evergreen Mountain,LLC and that 1
will agree to signing liability waiver form releasing Evergreen Mountain,LLC from any injury I may sustain during the course. !n
•I understand that my deposit is non-refundable and non-transferable. However,in the case of an emergency,I understand
that Evergreen Mountain,LLC will work to provide a fair and equitable solution for both parties.
SIGNATURED ATE
212-1 ,
If paying by credit card,please complete th following: ❑ ascc ❑ ❑ VISA
NAME AS R APPEARS ON CREDIT CARD - - .AUTHORIZATION SIGNATURE ;DATE
CREDIT CARD NUMBER EXPIRATION DATE 3 DIGIT AUTHORIZATION CODE
IMPORTANT: Your credit card will be charged the day your registration form is received. Please include the bill-
ing address where the monthly statement is sent.
ADDRESS CRY STATE i ZIP CODE
I
PLEASE MAKE CHECK/MONEY ORDER PAYA13LE TO:EVERGREEN MOUNTAIN,LLC
SCAN
• EMAIL REGISTRUPTI• •' i •• 7��• • '•C , • •
® INDIANA RETAIL TAX EXEMPT PAGE
CERTIFICATE NO.003120155 002 0
C
itof Carmd PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 32756
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
Evorgmen mountain LLC Carmel Police Dopait►alent
VENDOR
SHIP 3 C1,11c square
P.O. Box 1169 TO Carmel, IN 46032
` wE, NNI 87671-116
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-570.00
2 Each training $824.00 $1,648.00
Sub`dotal: $1,648.00
44
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IS4J n 1p o Trainln -Va nW alterT Dade n p c F1 M ay_ �I y48 in,F r VP,W
Send Invoice To: '-
Cannel Police Department
Attn: Pat Young
3 Civic Square
Camiel, IN 45032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT
Camiel Police Dept. $1,84 s.Uu
PAYMENT
` A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY YHATTHERE ISHAN UNOBLIGATED BALANCE IN
SHIP REPAID. {{
THIS APPROP.IATlN SUFFIC ENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY ), �I.�
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. Ild of
Pollec9
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE l
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. V
CLERK-TREASURER
DOCUMENT CONTROL NO- 32756 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
DET.#or INVOICE NO. ACCT#�rITLE AMOUNT 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_
20
Signature
Title
Cost distribution ledger classification if
claim paid motor.vehicle highway fund
1
VOUCHER NO. WARRANT NO.
ALLOWED 20
Evergreen Mountain LLC
IN SUM OF$
P.O. Box 1169
Taos, NM 87571-1169
$1,648.00
ON ACCOUNT OF APPROPRIATION FOR
CPD Continuing Ed Fund
PO#/Dept. INVOICE NO. ACCT#/rITLE AMOUNT Board Members
�
32756 151 -570.00 $1,648.00
I hereby certify that the attached invoice(s), or� I
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
Wednesday, ebruary 04, 2015
4/Z Chief of Police
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))
02/04/15 151 sniper training-Devenport,VanNatter $1,648.00
I
I
�j
j
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
j with IC 5-11-10-1.6
I
20
Clerk-Treasurer