242306 02/17/15 CAA _
�>`'� ._,+�. - CITY OF CARMEL, INDIANA VENDOR: 00351400
r d ONE CIVIC SQUARE IFCA MEMBERSHIP APPLICATION CHECK AMOUNT: $*--475.00*
,. r CARMEL, INDIANA 46032 PO BOX 305 CHECK NUMBER: 242306
9M. CAMBY IN 46113-0305 CHECK DATE: 02/17/15
���ON�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4355300 475.00 ORGANIZATION & MEMBER
2015 IFCA Membership Invoice Summary FPF °N Epq
INDIANA FIRE CHIEFS ASSOCIATION
9 0
To: Carmel Fire Department °
0P�
N�EU 9EPTfMO .
2 Civic Square
Carmel, IN 46032
Phone: 317-571-2600 Fax: 317-571-2615 ---- - -- ---- ---
Population Served: Dept.Type and Size (Career/Vol/Combin): Member Type Dues
State Senate District: US Congress District: Department Budget: Active(1st two Chiefs,any rank) $75 each
State Rep District: IDHS District 5 Active(Addt'i Chiefs, any rank) $50 each
Departmental (<30 in Dept,all ranks) $100 total
In 2014, the individuals listed below with your department were members of the Indiana Fire Chiefs DepartAssociamental
Non Chief t, Other) $50 each
Association. We certainly hope those of you who were 2014 members will renew and encourage others $50 each
in your department to join as well in 2015. Please call with any questions concerning membership rates. Section Dues(EMS,Aviation, Public
Safety Educators,Technical Rescue)
Note: We request that you review and correct this summary (especially blanks above). Mutual Aid Section-no charge
Please change online or fax, email or mail to Dale Henson, Executive Director IFCA.
-TIONAM' I AIL M1tM` 6E'1RSHlP' DUES,
1. Fire Chief Matthew Hoffman mhoffman@carmel.in.gov Active $0.00 $75.00
Section(s):
2. Assistant Fire Chief 44a carrrrehi'rrtgov' Active $0.00 $75.00
�Q cc�ca'va_
Section(s):
Lz'-%Z%ao '.
To Add A New Member: To Remove A Member: To Change Data:
Please add on this form the new members name, rank and Please note on the summary which member will not be Please change or add information to
email address and determine any additional dues that may be renewing and adjust the amount due by referring to the the data fields on this form. Attach
owed. membership dues structure. sheet if several changes
IFCA Membership Application P.O. Box 305 1 Camby, IN 46113-0305 1 dhenson@indfirechiefs.org
TEL : 1- (877 ) 733 - 1850 1 FAX : ( 3 1 7 ) 856-5949 1 www.indfirechiefs.org
2015 IFCA Membership Invoice Summary
INDIANA FIRE CHIEFS ASSOCIATION
9p o�
To: Carmel Fire Department
rf0 9EPTEK'0
2 Civic Square
Carmel, IN 46032
3• Assistant Fire Chief Robert Hensley bhensley@carmel.in.gov Active $0.00 $50.00
Section(s):
4. EMS Chief Active $0.00 $50.00
Section(s): O_oo a�S``�"'`\ �•t s� �, car m�\. r .�o�!
5. Public Education Keith Freer kfreer@carmel.in.gov Active $25.00 $50.00
Director
Section(s): Public safety Education
6. Fire Marshal Bruce Knott bknott@carmel.in.gov Active $0.00 $50.00
Section(s):
7. Battalion Chief Jeff Steele jsteele@carmel.in.gov Active $0.00 $50.00
Section(s):
To Add A New Member: To Remove A Member: To Change Data:
Please add on this form the new members name, rank and Please note on the summary which member will not be Please change or add information to
email address and determine any additional dues that may be renewing and adjust the amount due by referring to the the data fields on this form. Attach
owed. membership dues structure. sheet if several changes
IFCA Membership Application I P.O. Box 305 1 Camby, IN 46113-0305 1 dhenson@indfirechiefs.org
TEL : 1- (877 ) 733 - 1850 1 FAX : ( 3 1 7 ) 856-5949 1 www.indfiireChiefs.org
2015 IFCA Membership Invoice Summary �\PP CNIEfg �O
INDIANA FIRE CHIEFS ASSOCIATION
9 p
To: Carmel Fire Department
o
1ti EP,
�fl. 8EPTEW'0
2 Civic Square
Carmel, IN 46032
8. Safety Chief Mark Cromich mcromlich@carmel.in.gov Active $0.00 $50.00
Section(s):
Please Send Receipt: ❑ Check(payable to IFCA)#: Renewal Total: $450_00
Section Dues: $25.00
Visa Mastercard Card Number: + -
---- --- New Members:
Name on Card: Exp Date: Total Due:
�
Signature: �5.'c)
Online Payment Option -Visit: www.indfirechiefs.org under the membership tab
New Members (write name, rank, email and any section changes below or submit changes online):
cz�lV
To Add A New Member: To Remove A Member: To Change Data:
Please add on this form the new members name, rank and Please note on the summary which member will not be Please change or add information to
email address and determine any additional dues that may be renewing and adjust the amount due by referring to the the data fields on this form. Attach
owed. membership dues structure. sheet if several changes
-- ------ -- ------ -- ---- — ---- -----------------
------------------------
IFCA Membership Application P.O. Box 305 1 Camby, IN 46113-0305 1 dhensori@indfirechiefs.org
TEL : 1- (877 ) 733 - 1850 1 FAX : ( 3 1 7 ) 856-5949 1 www.indfirechiefs.org
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))
$475.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
IFCA Membership
6J-V-
JV��Vo
- IN SUM OF $
'1' U C/l�l�'h
PO Box 305 IIJJ
Camby, IN 46113
$475.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 43-553.00 $475.00 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
FEB 9 6 ?015
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund