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Home My WebLink About256095 03/04/16 0"p'�• CITY OF CARMEL, INDIANA VENDOR: 362114 ® ONE CIVIC SQUARE KIP BENBOW CHECK AMOUNT: $*******337.50* fa, ,?� CARMEL, INDIANA 46032 6406 MANCHESTER DRIVE CHECK NUMBER: 256095 �'�roN�O' FISHERS IN 46038 CHECK DATE: 03/04/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4343002 030316 337.50 EXTERNAL TRAINING TRA VOUCHER NO. WARRANT NO. ALLOWED 20 Kip Benbow IN SUM OF$ $337.50 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 43-430.02 $337.50 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 MAR - 2 W )110- Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund CITY OF CARMEL Expense Report (required for all travel expenses) -INDIAN? ' EMPLOYEE NAME: Kip Benbow DEPARTURE DATE: TIME: k�= AM/ M DEPARTMENT: FIRE RETURN DATE: -zt,- TIME: \a AM/ REASON FOR TRAVEL: EMS Today Conference DESTINATION CITY: Baltimore, MD EXPENSES ARE FOR(check all that apply):,TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PER DIEM Transportation Meals Gas/Tolls/ Date Parkin Lodging Misc. Total Air-fare Car Rental Other g Breakfast Lunch Dinner Snacks Per Diem $0.00 $0.00 $0.00 $0.00 2/23/16 32.50 $32.50 2/24/16 a, a �_ a. �. a. 65.00 $65.00 1 k 2/25/16 65.00 $65.00 2/26/16 65.00 $65.00 2/27/16 45.00 65.00 `$110.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ,$0.00 $0.00 $0.00 $0.00 0.00 Total 1 $0.001 $0.001 $0.00. $4001 $0.001 $0.00 $0.00 $0.001 $0.00 $292.501$0.00 1 DIRECTOR'S STATEMEN I ereby affirm that all a penses listed conform to the City's travel policy angtg vithm,y,. bepartment's appropriated budget. Director Signature: fl Date: h City of Carmel Form#ER06 Revision Date 3/2/2016 Page 1 Hyatt Regency Baltimore 300 Light Street . { Y T T Baltimore, MD 21202 It, * n R C C c �\� Tel: 410-528-1234 C T Fax:410-685-3362 baltimore.hyatt.com INVOICE Payee Tim Fagin Room No. 0732 13434 Spotswood St Arrival 02-23-16 Carmel IN 46032 United States Departure 02-27-16 Page No. 1 of 1 Confirmation No. 1115134701 Folio Window 1 Group Name EMS Today Conference & Exposition Folio No. 509011 Booking No. . -_ 32D5QJPR Date Description Charges Credits 02-23-16 Check 255248 716.12 02-23-16 Group Room 155.00 02-23-16 State Sales Tax 6% 9.30 02-23-16 City Occupancy Tax 9.5% 14.73 02-24-16 Group Room 155.00 02-24-16 State Sales Tax 6% 9.30 02-24-16 City Occupancy Tax 9.5% 14.73 02-25-16 Group Room 155.00 02-25-16 State Sales Tax 6% 9.30 02-25-16 City Occupancy Tax 9.5% 14.73 02-26-16 Group Room 155.00 02-26-16 State Sales Tax 6% 9.30 02-26-16 City Occupancy Tax 9.5% 14.73 Total 716.12 716.12 Guest Signature Balance 0.00 I agree that my liability for this bill is not waived and I agree to be held personally liable in the event that the indicated WE HOPE YOU ENJOYED YOUR STAY WITH USI person,company or association falls to pay for any part or the full amount of these charges. - - Thank you for staying with us at the Hyatt Regency Baltimore,we look forward to seeing you again!We are very interested in hearing about your stay. Hyatt Gold Passport Summary Please share your thoughts directly with: No Membership to be credited Aaron McDougle, Director of Rooms aaron.mcdouole anhyatt.com or by mail attn: Join Hyatt Gold Passport today and start Aaron McDougle,300 Light Street, Baltimore, MD 21202 earning points for stays, dining and more. Visit gold passport.ccm For inquiries concerning your bill, please call 888-588-6308 Please remit payment to: Hyatt Regency Baltimore P.O. Box 842215 Dallas,TX 75284 Snyder, Denise.W From: Tunstill, Debbie -The Travel Agent <Debbie.Tunstill@thetravelagentinc.com> Sent: Monday,January 25, 2016 23:04 To: Snyder, Denise W Subject: Confirmed Flight for Kip Benbow SALES PERSON:DT2 ITINERARYANVOICE NO. ITIN DATE:JAN 25 2016 ACCOUNT POP5BO PAGE: 01 FOR: BENBOW/KIP S TO: CITY OF CARMEL CITY OF CARMEL-FIRE DEPT ONE CIVIC SQUARE-3RD FLOOR ATTN: DENISE SNYDER CARMEL IN 46032 TWO CIVIC SQUARE CARMEL IN 46032 ----------------------------------------------------------------------- 23 FEB 16-TUESDAY MILES- 515 ELAPSED TIME- 1:40 AIR LV INDIANAPOLIS 730P SOUTHWEST FLT:2721 COACH CLASS CONFIRMED AR BALTIMORE 910P NONSTOP AIRLINE CONFIRMATION:WN-RNGRVO 27 FEB 16-SATURDAY MILES- 515 ELAPSED TIME- 1:55 AIR LV BALTIMORE 720P SOUTHWEST FLT:3240 COACH CLASS CONFIRMED AR INDIANAPOLIS 915P NONSTOP AIRLINE CONFIRMATION:WN-RNGRVO THIS IS AN ELECTRONIC TICKET. PLEASE PRESENT PHOTO ID AND CONF NUMBER AT CHECK IN. TICKET IS COMPLETELY NON REFUNDABLE IF UNUSED. MAY CHANGE ONLY PRIOR TO ORIGINAL TRAVEL DATE. FEES MAY APPLY. SOUTHWEST CONF RNGRVO THANK YOU.DEBBIE TUNSTILL 317 805 5762 "VERIFY ALL INFO IS CORRECT.FEES APPLY FOR REISSUES-REFUNDS-CHANGES EMERG.AFTR HRS 877-645-6373 CODE A09$20 PER TRANSACTION A 15PCT FEE OF TOTAL COST APPLIES FOR CANCELLATIONS FOR TERMS AND CONDITIONS SEE WWW.TTA.TRAVEL THIS ITIN MAY BE SUBJECT TO CABIN INSECTICIDE SPRAYING PRIOR TO FLIGHT OR WHILE ON THE AIRCRAFT.FOR REQUIRING COUNTRIES SEE WWW.TZELL41 LCOM LIKE US ON FACEBOOK HTTP://WWW.FACEBOOK.COMITHETRAVELAGENTINC AIR TRANSPORTATION 196.98 TAX 42.98 TTL 239.96 PROCESSING FEE -•.35.00 SUB TOTAL 274.96 CREDIT CARD PAYMENT 274.96- TOTAL AMOUNT 0.00 MYTRIPANDMORE.COM/BAGGAGEDETAILSWN.BAGG 1 EMS �-t_'•�' FEBRUARY 2s-�7, �o�6 TODAYBaltimore Convention Cerner t . TM Baltimore, Maryland CELEDRATYNt,� ,Y First Name �11r� Last Name YS JobTitiir,,, cm5 'r 04�C Organization `C�'�C E �1� I + 1 • • 1.Online. Address 1 / � .. 2.Email: � G i C Address 2 City Car i State/Province Postal Code~ `t to b3L Only) 1-918-831-9161 Country V5 P ( ) -3)-1 J i 2— o Fax(+) r . Telephone + •� :. r Dallas,TX . USA Email I�-�3Cr4�t�� + L' �•�e 1� r �1n3`� Your individual email address is required-confirmation is sent via email and is needed for CEH certificate login. If you have multiple licenses or an NREMT#,please contact registration via phone or email, Certification/License#: 83 7 8 S`5J License State: Date of Birth; (moi!j ®-7 1 -7y License Type(E.G.,EMT-B,EMT-P) LIvTT A License Category(BLS,ALS,or Other) LS License Expiration Date: 110 O I L _ 'PROMOCODE* *What's this?Promo codes are direct Mail pieces,eMails and advertisements.They are . to. . and/or PLEASE1 t QUESTIONS 1.OCCUPATION/POSITION (CHOOSE ONLY 1) 2.EMPLOYER/AFFILIATION(CHOOSE ONLY 1) 3. PURCHASING ROLE A. Paramedic ❑ 1. Hospital (CHOOSE ALL THAT APPLY) B. EMT Basic ❑2. Private Ambulance ❑ FA Purchase ❑ C. EMT-I,EMT•D ❑-3.- Volunteer Fire DeptJRescue Squad ❑ FB Approve ❑ D. First Responder 4. Paid Fire Dept/Rescue Squad ❑ FC Recommend ❑ E. Emergency/Public Safety Manager b 5. Combination Fire Dept./Rescue Squad ❑ FD Specify. ❑ F. Physician ❑ 6. Third Service/MunicipalAgency FE Influence ❑G. Medical Director ❑ 7. Industrial/Commercial ❑J. Registered Nurse ❑8. Educational Institution ❑ K. Instructor/Coordinator/Trainer ❑ 9. Military/Government ❑ L. Administrator/Supervisor ❑ 10.Other ❑ M.EMS Chief ❑ N. Fire Chief ❑ P. Other Chief ❑ R. Pres,Dir,CEO,VP,Mgr ❑.5 Captain/Lt/Commander/Other Officer ❑T. Student ❑ 0. Other(Specify) �' Pell' EVENT REGISTRATION PRICING Passpo3iahr i Silver Passport(2-Day) .........................................."Early-6!!d:$320.......................................Regular:$420" Single Day Full'Conference......................................... Early-Bird:$205.... .Regular:$305 Exhibitor Full Conference......................................... Early-Bird:$175.......................................Regular:$175" -Exhibit Hall Visitor Only........................................... Early-Bird:$30........................................Regular:$40. PRE-CONFERENCEWORKSHOPS Please select the Pre-Conference Workshop you would-like So attend and add the price to ybi}r registration total.All are at a first-come,first-served basis.Lunch is included with all 8-hour(full day)workshops and two,4-hour(half day)workshops. Early Bird Rates expire:January 15,2016 WEDNESDAY, FEBRUARY 24,2016 HALF-DAY WORKSHOPS. FULL-DAY WORKSHOPS ❑ Boosting Your Organization's Recruitment,Retention&-Reputation Active Shooter Simulation Lab 8:00AM—12:OOPM- . or 1:00PM-5:00PM Early Bird:5125.00 Regular.5150.00 B;� —5:00PM Early Bird:$215.0.0 Regular:5240.00 ❑EMT"Design It Yourself"Refresher Workshop 8:00AM—12:OOPM or 1:OOPM 5:OOPM ❑ Community Paramedicine Preconference Workshop Early Bird:5125.00 Regular 5150.00 8:00AM—5:OOPM ❑NEMSMAs Pressing Topics in EMS Management Early Bird:$215.00. Regular.5240.00 8:00AM—12:DOPM Early Bird:$125.00 Regular:5150.00 ❑ EMS Compass Town Hall Meeting:How Performance Measures Could Transform EMS BSOOAM—5:00PM ❑Self Defense Tactics for EMS Providers Early Bird:$215.00 Regular.$240.00 8:00AM—12:OOPM or 1:OOPM—5:00PM Early Bird:5125.00 Regular.$150.00 LUNCH&LEARNS ❑ Cadaver Lab 1:00PM—5:00PM ❑ Medtronic Lunch&Learn Early Bird:$75.00 Regular.$75,00 A Critical New Role for EMS in Improving Stroke Outcomes ❑ Emergency Medical Response to the Active Shooter Thursday,February 25,2016 12:00PM—1:30PM...........................:Fee:510, 1:OOPM—5:00PM Early Bird:S125.00 Regular.$150.00 ❑Zoll Lunch&Learn Friday,February 26,2016 12:OOPM—1:30PM............................Fee:$10 CREW PRICING [ M.ILITAR- YPRICIrNG More People More Savings!" , Price - Early Bird Rate- Regular Rate- before 1115116 after 1115116 Amount of people Price Name of"reg type $275 $325 3-5 $1,000 CODE ALPHA ° $200 $250 6-10 $2,000 CODE BRAVO 11+ 52,500. CODE CHARLIE Q 1-Year subscription to JEMS($44 Value) Please check Your registration fee includes a 1-year ' ° ' ° ° ° print subscription.to JEMS magazine. Ride Along ° ' ' ' available. ❑ .Check here if you do not wish to receive JEMS. All are complimentary. You will not be refunded the subscription rate. TOTAL DUE METHOD OF PAYMENT f Payment must be received prior to conference Please add all selections :S l- ❑Check Enclosed(U.S.-funds only.Checks payable to PennWell/EMS Today 2016) and total here: - [I Wire Transfer(wiring info provided upon confirmation) ❑Credit Card: PROMO CODE: ❑Amex.❑Visa -❑Mastercard ❑Discover ❑Diners Club Payment must be received by published date to receive early registration discounts. -Gard Number Cancellations must be received in writing by February 8,2016 to receive a refund minus Exp.Date Penn a$75.00 administrative fee.N0 REFUNDS will be permitted after February 8,2016. Name on Card Substitutions may be made at any time by written notification to the registration office. Signature