252539 12/15/15 q CITY OF CARMEL, INDIANA VENDOR: 013514
® h ONE CIVIC SQUARE APCO INTERNATIONAL, INC CHECK AMOUNT: S""""""""92.00`
=4 CARMEL, INDIANA 46032 351 N WILLIAMSON BLVD CHECK NUMBER: 252539
9MrON� DAYTONA BEACH FL 32114-1112 CHECK DATE: 12/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4355300 308659 92.00 ORGANIZATION & MEMBER
ANNUAL DUES INVOICE
APCO Federal ID#: 63-0461885
CO
` AI'CO INTERNATIONAL INC.
�' 351 NORTH wILLAMSON BLVD.
n�t''r n t r o n a I DAYTONA BEACH,FLORIDA 32114
APCO International 351 North Williamson Blvd.♦Daytona Beach,FL 32114 888-APC09-1-1 OR 386-322-2500
Janet Arnone Org Number: 308659
Office Administrator Statement Date: 12/3/2015
Carmel Clay Communications Center
31 1 St Ave NW P.O. Number:
Carmel, IN 46032-1715 Total Amount Due: $92.00
Total Amount Paid:
2016 APCO Membership Dues-To make chanp-es to your invoice:
• Individuals no longer with your organization: draw a line through their name.
• Individuals with your organization; but no longer on the invoice: draw a line through their name and check the box.
•Add New Members: Each new member requires an application; download and duplicate, as needed,the application at
www.apcointl.org/join.Return application with payment.
MBR# CAT. NAI\,IE DESCRIPTION AMOUNT DUE
Primary Chapter Original Amt Amount Due Total Paid Balance
96115 FULL Todd Luckoski ❑ 0 IN 592.00 $92.00 $0.00 S92.00
Total Amount Due: $92.00
RETURN INVOICE WITH REMITTANCE. RETAIN A COPY FOR YOUR RECORDS.
Select Payment Method
❑ Check Enclosed#: ❑ M/C ❑ VISA ❑ AMEX Exp Date /
Card# Card Holder's Name
Card Holder's Signature Card Holders E-mail:
Page 1 of 1
Public Safety Practitioner
Commercial members use application at:www.apcointi.org/commercial-application
NAME TITLE
PRIMARY CONTACT(group membership only)
ORGANIZATION AMATEUR CALLSIGN
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
amu_
❑ Full Member:Tier One—$92 USD Agency Category—Please select one that best fits: F
Individualswho 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 r
EMS ❑ Other
design,construction,installation,command. ❑
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 ;
in California,Louisiana and Oregon are to select ❑ Engineer/Technician ❑ Telecommunicator
this Tier.(Note:Tier selection/membership dues ❑ Information Systems /Dispatcher
❑ Manager ❑ Training&Education .--
are set by each respective Chapter.) ❑ Police Chief Coordinator
❑ Associate Member—$69 USD ❑ Other
Individuals who perform non-administrative and/ _41o o
or non-supervisory functions within their agency.
Associate members do not have voting privileges. ❑Check enclosed u ❑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 PRINTNAME
of any other number of Chapters.Please list the
additional Chapters by name: CARDHOLDER'S EMAIL
Mail completed application with payment to:
APCO
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
•o of applicable dues.
........................................................................................................................ :..
Membership Levels Tier 1 Tier 2
(CA,LA,OR) *Note:$35 of your membership goes to your subscription to Public ;%•
Safety Communications.APCO International annual dues are
❑ Level One ❑ $331 ❑ $413 not a deductible contribution for federal tax purposes.but may be
(Up to 10 staff) deducted as a business expense.Public Safety Communications a,•.,'
❑ 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)
f
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.
i
Payee
Purchase Order No.
Terms
Date Due
Invoice Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s) or bill(s))
s•
12/03/15 I 308659101 I $92.00
1115
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
APCO INTERNATIONAL, INC
351 N WILLIAMSON BLVD IN SUM OF $
DAYTONA BEACH, FL 32114-1112
$92.00
ON ACCOUNT OF APPROPRIATION FOR
PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members
308659 I 43-553.00 I $92.00 I hereby certify that the attached invoice(s), or
1115 101
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
Monday, December 14, 2015
Terry Crockett, Director
Cost distribution ledger classification if
claim paid motor vehicle highway fund