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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