HomeMy WebLinkAbout253095 01/11/16 �%�'""f. CITY OF CARMEL, INDIANA VENDOR: 00351400
® ,�
�;• ONE CIVIC SQUARE IFCA MEMBERSHIP APPLICATION CHECK AMOUNT: S*'*"**450.00*
r. is CARMEL, INDIANA 46032 PO BOX 305 CHECK NUMBER: 253095
v,�iloNf` CAMBY IN 46113-0305 CHECK DATE: 01/11/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4355300 450.00 ORGANIZATION & MEMBER
2016 IFCA p ,.Membershi Invoice Summary ;�� �� •..
,
INDIANAFIRE CHIEFS ASSOCIATION;
To: Carmel Fire Department f
2 Civic Square
Carmel, IN 46032 I
Phone: 317-571-2600 Fax: 317-571-2615
2-P16 MEMBERSHIP DUES STRUCTURE
Population Served: Dept Type a. d 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
I
Departmental(<30 in Dept,,all ranks) $100 total
In 2015;the individuals listed below with your department were members of the Indiana Fire Chiefs Associate]>30,Non Chief or other) $50 each
Association. We certainly hope those of you who were 20'5 members will renew and encourage others in section D, es_(EMs,Aviation,Public $25 each
.your department to join as well in 2016. Please call with ariy.questions concerning membership rates. Safety Educators,Technical Rescue)
Note: We request that.you review and correct this summary(especially blanks above). Mutual.A! Section-no charge
Please change online or fax,email or mail to Dale Hendon,Executive Director,IFCA.
'LSECTITITLE NAME EMAIL MEMBERSHIP • AMT. DUE
1. Fire Chief ew Ho man n@carmel.in.gov Active, ' $0.00 $75.00
Section(s): v'� u U1lDou15r)ri Ca�Me�.cin•�J
2. Assistant Fre Chief Orbie Bowles obowles@carmel.in.gov Active $0.00 $75.00
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 stricture. h sheet if several changes .
IFCA Membership Applicatia�. P.O: Box 305 1,Camby, IN 46113-0305 dhenson@ ndfirechiefs.org.
TEL: 1-(877 ) 7�3 - 1850 1 F A X ( 3 17) 856-5949 1 www.indfi iefs.org
2016 IFCA Membership Invoice Surnmary s� y
INDIANA'FIRE CHIEFS ASSOCIATION;
To: Carmel Fire Department
2 Civic Square
�
Carmel,IN 46032 .
3. Assistant Fre Chief Robert Hensley I bhensley@carmel.in.gov Active $0.00 $50.00
Section(s):
4. EMS Chief Tom Small tsmall@carmel.in.gov Active $0.00 $50.00
Sectlon(s):
5. Battalion Chief Jeff Steele jsteele@carmel.in.gov Active $0.00 $50.00
Section(s): 1
6. Safety Chief Mark Cromich mcromlich@carmel.in.gov Active $0.00. $50.00
Section(s):
7. Public Education Keith Freer kfreer@carmel.in:gov Active $25.00. $50.00
Director
Section(s): Public Safety Education
II,
I'
I,
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
Pleasedhange or add'information to
email address and determine any additional dues that may be I. renewing and adjust the amount due by referring to the. the data fields on this form. Attach
owed. ;I membership dues structure. sheet if several changes .
IFCA Membership Application P.O. Box 305 Camby, IN 46113-0305 1 dhenson@indfirechiefs.org
T E L:. 1-(877.) 733 1850. FAX :- ( 3;17 ) . 856-5949 wwMindfi iefs.org
i. r
2016 IFCA p Membershi Inv
;®ice Summary
INDIANA FIRE CHIEFS ASSOCIATION
To: Carmel Fire Department ! °a
2 Civic Square
Carmel, IN 46032
8. Fire Marshal Bruce Knott bknott@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:
Online Payment Option-Visit: www:indfrechiefs.org under the membership tab
New Members(write name, rank, email and any'section changes below or submit changes online):
i
I
1
I
4
To Add A New Member: To Remove A Member: To Change Data:
Please add on this form the newmembers 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 Camby, IN 46113-0305. 1 dhenson@ijidfirechiefs.org
TEL .1-(877) 733 - 1850 F A X : ( 3 17 ) 856-5449 www.indfirec iefs:org
rescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
,n invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
Thom, rates per day, number of hours, rate per hour, number of units, price per unit,etc.
Payee
Purchase Order No.
Terms
Date Due
nvoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
$450.00
hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
nrith IC 5-11-10-1.6
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
I FCA
IN SUM OF$
PO Box 305
Camby, IN 46113
$450.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 43-553.00 $450.00 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
JAN
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund