HomeMy WebLinkAbout255761 03/01/16 ~�� CITY OF CARMEL, INDIANA VENDOR: 00353280
® 1 I ONE CIVIC SQUARE FBI/LEEDA CHECK AMOUNT: $********50.00*
%Q CARMEL, INDIANA 46032 5 GREAT VALLEY PARKWAY SUITE 125 CHECK NUMBER: 255761
'�RroN'i�. MALVERN PA 19355 CHECK DATE: 03/01/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4355300 5537-16 50.00 ORGANIZATION & MEMBER
• FB1=LEEDA
p� Law Enforcement Executive Development Association
E R
CEIVED
SEB 16 20.16:.
Chief'of.Police,Tim J.-Green: : Invoice# 5537-16. BY:
Carmel Police Department : ..
3Zvic.Square.
Carmel;.I:N 460.32
*FIN,AL .NOTICE*.-F-BI-LEEDA'.DUES INVOICE,- 201.6
.Thank-you.for being a memberof FBI-LEEDA. Your membership'reaffirms-your com.mitme.nt to continued:
leadership and management training for you and for members Of your department.:
Membership Number:, 5532
Name:. Tim J.,Green
Title: Chief of Police.
Agency: Carmel Police Deparfinent:
Mailing Address:, 3 CiVic Square.
Carmel; IN 46032
Agency Telephone: 317=571-2500.
Email: : tgreen@carmel:.in:gov..
(If.your email is not listed above, of is incorrect, please correct, as:future.dues 'invoices will be sent-via email.)
20.16 Annual D.ues:. $:50:00 USD (due.by.March 10, 20116)- .:'
Reference Invoide#::5537616,on check,and make checks payable to FBI-LEEDA
Please include a:copy.of:this invoice;and any'updated.contact,information and mail to:
FB::I-LEEDA, Attn: Membership:
5_Great Valley:Parkway Suite:125
-Malvern, PA 19355: :
Tel: 877-772-7712. 6 Fax: 610-644-3193 • Email:shonts@fbileeda.org
You..can renewyour membership.on-line at
www.fbileeda.org=-VISA!-*.MASTERARD.*AMEX accepted. ;
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
02/16/16 5537-16 Annual membership dues $50.00
1110 101
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
fAW
1
CITY .O`, _ EL
JAMES BRAINARD, MAYOR
February 8, 2016
EVAN FARTHING
9751 PLEASANT WAY
INDIANAPOLIS, IN 46280
RE: RUN#20155777:1 DOS 11/10/2015 Sarah Farthing
DEAR EVAN FARTHING:
Enclosed you will find a refund check for $20.99
United HealthCare reprocessed your claim on 12/15/2015.
The claim listed patient responsibility $206.61 and you paid the amount due.
United HealthCare reprocessed the claim and the corrected patient responsibility
is $185.62. Refund to be issued to Evan Farthing.
If you have any questions,please feel free to contact me at (3 17) 571-2604.
Sincerely,
Michelle T. Harrington
EMS Billing Administrator
CARNIEL FIRE DEPARTNiENT
STEVEN A. CouTs HEADQUARTERS -
Two Cmc SouARE, CAPNIEL. IN 46032 OFFIcE 317.571.2600, FAx 317.571.2615
348PROVEA2001001-01477-08 1T-581 1*05*000009-PM-1 5348-120*007ASOJPMCTOPS
STD-EOB
United HealthCare Services,Inc. UnitedHealtheare`
SPRINGFIELD SERVICE CENTER AUnitedHealthGroup Company
PO BOX 740800
ATLANTA,GA 30374-0800
PHONE:1-877-842-3210
DATE: 12/14/15
TIN: 35-6000972
NPI: 1154325579
CARMEL FIRE DEPT AMBULANCE SVC GROUP NUMBER: 0717473
CARMEL FIRE DEPT AMBULANCE SV GROUP NAME: DANAHER CORPORATION
2 CIVIC SQ CHECK NUMBER: PH 91618672
CARMEL IN 46032 CHECKAMOUNT: $645.36
PROVIDER
EXPLANATION OF
BENEFITS
PATIENT:SARAH FARTHING (SP)
MEMBER NAME: EVAN FARTHING CONTROL NUMBER: 572685973001
MEMBER ID: A 836898669 DATE RECEIVED: 12/01/15
PRODUCT: CHOYC+ PROVIDER OF SERVICE: CARMEL FIRE DEPT AMBU
PATIENT ACCOUNT: 20155777-1
DATE(S)OF DESCRIPTION OF AMOUNT NOT COVERED PROV ADJ AMOUNT DEDUCT COPAY PLAN PAID TO RMK PATIENT RESP
SERVICE SERVICES CHARGED DISCOUNT ALLOWED COV PROVIDER CD
.11/10/15 AMBULANCE $5.75:00 :$57500. - $66:17 ;80% F.$405.46M6.
11/10/15 AMBULANCE $80.40 $80.40 800/0 $64.32 M6
11/10/15' AMBULANCE $000 `=$448 79 �`= ' 100% x`-$4:48:79 OH'
w
CONTROL#572685973001 $655.40 $206.61 $68.17 $20.99,# JP $185.6;
SUBTOTAL:
TOTAL PAYABLE TO,PROVIDER $x45:36
REMARKS:
(OH) WE HAVE RECEIVED MORE INFORMATION AND REPROCESSED THIS CLAIM.THIS IS THE AMOUNT THAT WAS ALREADY PAID.
(JP) IT IS IMPORTANT FOR US TO KNOW WHETHER OR NOT YOU OR YOUR COVERED FAMILY MEMBER(S)HAVE OTHER INSURANCE.THIS WILL HELP US PAY YOUR CLAIMS
QUICKLY AND ACCURATELY.WE ASK FOR THIS INFORMATION EVERY YEAR BECAUSE COVERAGE CAN CHANGE.TO UPDATE THIS INFORMATION,GO TO THE
COORDINATION OF BENEFITS SECTION ON YOUR MEMBER WEBSITE OR CALL US TOLL FREE AT 1-888-262-4001.
(M6) THIS IS A RECONSIDERATION OF A PREVIOUSLY PROCESSED CLAIM.
(#) PAYMENT OF BENEFITS HAS BEEN MADE IN ACCORDANCE WITH THE TERMS OF THE MANAGED CARE SYSTEM,
THE MEMBER,PROVIDER,OR AN AUTHORIZED REPRESENTATIVE MAY REQUEST RECONSIDERATION OR APPEAL THE DECISION BY SUBMITTING COMMENTS,
DOCUMENTS OR OTHER INFORMATION TO UNITEDHEALTHCARE. NETWORK PROVIDERS SHOULD REFER TO THE ADMINISTRATIVE GUIDE FOR CLAIM
RECONSIDERATION OR APPEAL INFORMATION. IF YOU ARE A NETWORK PROVIDER APPEALING A CLINICAL OR COVERAGE DETERMINATION ON BEHALF OF
A MEMBER,OR A NON-NETWORK PROVIDER APPEALING A DECISION ON BEHALF OF A MEMBER,FOLLOW THE PROCESS FOR APPEALS IN THE MEMBER'S
BENEFIT PLAN DOCUMENT. DECISIONS ON APPEALS MADE ON BEHALF OF MEMBERS WILL BE COMPLETED IN 30 DAYS OF SUBMISSION OR WITHIN THE
TIMEFRAME REQUIRED BY LAW.
UNITEDHEALTHCARE IS IMPROVING SERVICE TO YOU BY ADOPTING ELECTRONIC PAYMENTS&STATEMENTS(EPS)AS A STANDARD WAY TO PAY CLAIMS.
EPS WILL DRAMATICALLY REDUCE THE TIME AND EFFORT YOUR ORGANIZATION SPENDS ON ADMINISTERING PAPER CHECKS AND EXPLANATION OF
BENEFITS. GET A HEAD START AND ENROLL TODAY BY SELECTING THE ELECTRONIC PAYMENTS&STATEMENTS LINK FOUND ON THE HOME PAGE
WWW.UNITEDHEALTHCAREONLINE.COM OR CONTACT US AT 1-866-UHC-FAST(1-866-842-3278),OPTION 5. FOR MORE INFORMATION ABOUT OUR FREE
OR LOW COST SOLUTIONS FOR SUBMITTING CLAIMS ELECTRONICALLY TO UNITEDHEALTHCARE AND OTHER PAYERS,PLEASE CONTACT US TOLL FREE AT
1-800-842-1109,OPTION S.
Page 9 of 9
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))
Total
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
20Clerk-Treasurer
® Remit to INVOICE
FASTBVAL Fastenal Company Page 1 of 1
P.O. Box 1286
Winona, MN 55987-1286 Invoice Date Invoice No.
02/03/2016 ININ820869
Cust. No. ININ80387 For billing questions
Cust.P.O. 1010 Kendall Court, Suite 3 Invoice Total
Job No. WESTFIELD, IN 46074 53.38 USD
Contract No. QPA 13090 Phone 317-804-8035 Due Date
Fax 317-804-8037 03/04/2016
Sold To
0003286 01 AB 0.413 "AUT0 T7 2 1009 46280-2-03286
I..'I��Ir" ' 'III�I'll' III'IrII����IIII�I"�II�"I�'I'�I'lll'I� Ship To
CARMEL WASTEWATER TREATMENT Picked up at branch
9609 HAZEL DELL PKWY 1010 Kendall Court, Suite 3
INDIANAPOLIS, IN 46280-2935 WESTFIELD, IN 46074
This Order and Document is subject to the "Terms of Purchase"posted on www.fastenal.com.
Line Quantity Quantity Quantity Control Part Price/
No Ordered Shipped Backordered Description No. No. Hundred Amount
1 30 30 0 3/4"-10 FHNz 5 120234525 1136316 25.9800 7.79 Y
2 10 10 0 HCS3/4-10x3 1/2 Z 5 180092417 110120439 141.7500 14.18 Y
3 20 20 0 HCS3/4-10X4 G5 Z 120206130 110120441 157.0500 31.41 Y
Received By Tax Exemption Subtotal 53.38
0031201550-020 G Shipping &Handling 0.00
Comments IN State Tax 0.00
County Tax 0.00
Contact:Duane Jarvis City Tax 0.00
Total 53.38
Reasonable collection and attorneys fees will be No materials accepted for return without our permission.
assessed to all accounts placed for collection. All discrepancies must be reported within 10 days.
If you re-package or re-sell this product,you are required to maintain Please pay from this invoice.
integrity of Country of Origin to the consumer of this product.
0003286-01-000988; Invoice: ININ820869 Cust: ININ80387
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
92000
FASTENAL COMPANY Purchase Order No.
PO BOX 1286 Terms
WINONA, MN 55987-1286 Due Date 2/18/2016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/18/2016 ININ820869 $53.38
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
I-- I"
Date icer
FASTBINLO
Remit to INVOICE
Fastenal Company
P.O. Box 1286 Page 1 of 1
Winona, MN 55987-1286 Invoice Date Invoice No.
02/11/2016 ININ820971
Cust.No. ININ80004 For billing questions
Cust. P.O. Jack 1010 Kendall Court, Suite 3 Invoice Total
Job No. WESTFIELD, IN 46074 214.20 USD
Contract No. QPA 13090 Phone 317-804-8035 Due Date
Fax 317-804-8037 03/12/2016
Sold To
0003451 01 AB 0.413 "AUTO T8 1 1010 46074-8-03451
III"I.����"�IIII'I��IrI..I'IIIA'I'I�III'll'I�I'I"II'lllll�lll Ship To
CARMEL UTILITIES Picked up at branch
3450 W 131 ST ST 1010 Kendall Court, Suite 3
CARMEL, IN 46074 WESTFIELD, IN 46074
This Order and Document is subject to the "Terms of Purchase" posted on www.fastenal.com.
Line Quantity Quantity Quantity Control Part Price/
No Ordered Shipped Backordered Description No. No. Hundred Amount
1 80 80 0 5/8"-11 Bras FHN 220018167 1175120 102.1500 81.72 Y
2 80 80 0 S/S HCS 5/8-11X2 1/2 WEINK0001 70313 165.6000 132.48 Y
Received By Tax Exemption Subtotal 214.20
0031201560-020 G Shipping&Handling 0.00
Comments IN State Tax 0.00
County Tax 0.00
Contact:Jack Spears City Tax 0.00
Total 214.20
Reasonable collection and attorneys fees will be No materials accepted for return without our permission.
assessed to all accounts placed for collection. All discrepancies must be reported within 10 days.
If you re-package or re-sell this product,you are required to maintain Please pay from this invoice.
integrity of Country of Origin to the consumer of this product.
0003451-01-0010571 Invoice: ININ820971 cust: ININ80004
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
92000
FASTENAL Purchase Order No.
P.O. BOX 1286 Terms
WINONA, MN 55987-1286 Due Date 2/22/2016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/22/2016 820971 $214.20
hereby certify that the attached invoice(s), or bill(s) is (are) true and
,orrect and I have audited same in accordance with IC 5-11-10-1.6
Date icer
FASTBINE
Remit to INVOICE
Fastenal Company Pae 1 of 1
P.O. Box 1286 g
Winona, MN 55987-1286 Invoice Date Invoice No.
02/05/2016 ININ820900
Cust.No. ININ80003 For billing questions
Cust.P.O. Signs 1010 Kendall Court,Suite 3 Invoice Total
Job No. WESTFIELD, IN 46074 10.14 USD
Contract No. QPA 13090 Phone 317-804-8035 Due Date
Sold To
Fax 317-804-8037 03/06/2016
Ship To
CARMEL STREET DEPT. Picked up at branch
3400 W 131 ST ST 1010 Kendall Court,Suite 3
WESTFIELD,IN 46074-8267 WESTFIELD, IN 46074
This Order and Document is subject to the"Terms of Purchase"posted on www.fastenal.com.
Line Quantity Quantity Quantity Control Part Price/
No Ordered Shipped Backordered Description No. No. Hundred Amount
1 25 25 0 5/16-18 X 3 S/S HCS 120210615 1170065 40.5500 10.14 Y
Received By Tax Exemption Subtotal 10.14
0031201550-020 G Shipping&Handling 0.00
Comments IN State Tax 0.00
County Tax 0.00
Contact:Jim Bentley City Tax 0.00
Total 10.14
Reasonable collection and attorneys fees will be No materials accepted for return without our permission.
assessed to all accounts placed for collection. All discrepancies must be reported within 10 days.
If you re-package or re-sell this product,you are required to maintain Please pay from this invoice.
integrity of Country of Origin to the consumer of this product.
Invoice: ININ820900 Cust: ININ80003
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
02/05/16 ININ820900 $10.14
2201 201
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
FASMMO
Remit to INVOICE
Fastenal Company Page 1 of 1
P.O. Box 1286
Winona, MN 55987-1286 Invoice Date Invoice No.
Cust.No. ININ80003
For billing questions 02/10/2016 ININ820943
Cust.P.O. Tarkington 1010 Kendall Court,Suite 3 Invoice Total
Job No. WESTFIELD,IN 46074 637.00 USD
Contract No. QPA 13090 Phone 317-804-8035 Due Date
Fax 317-804-8037 03/11/2016
Sold To
Ship To
CARMEL STREET DEPT. Picked up at branch
3400 W 131 ST ST 1010 Kendall Court,Suite 3
WESTFIELD, IN 46074-8267 WESTFIELD, IN 46074 .
This Order and Document is subject to the"Terms of Purchase"posted on www.fastenal.com.
Line Quantity Quantity Quantity Control Part Price/
No Ordered Shipped Backordered Description No. No. Hundred Amount
1 10 10 0 PC Board Red REPLfo WEIN1726 12728-00313 6,370.0000 637.00
Received By Tax Exemption Subtotal 637.00
0031201550-020 G Shipping&Handling 0.00
Comments IN State Tax 0.00
County Tax 0.00
Contact:Matt Higginbotham City Tax 0.00
Total 637.00
Reasonable collection and attorneys fees will be No materials accepted for return without our permission.
assessed to all accounts placed for collection. All discrepancies must be reported within 10 days.
If you re-package or re-sell this product,you are required to maintain Please pay from this invoice.
integrity of Country of Origin to the consumer of this product.
Invoice: ININ820M Cust: ININ80003
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s) or bill(s))
02/10/16 ININS20943 $637.00
2201 201
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
FASTBINLO
Remit to INVOICE
Fastenal Company
P.O. Box 1286 Page 1 of 1
Winona, MN 55987-1286 Invoice Date Invoice No.
02/08/2016 I N I N 820920
Cust.No. ININ80003 For billing questions
Cus1010 Kendall Court,Suite 3 Invoice Total
Job No.P.O. Star WESTFIELD, IN 46074 111.51 USD
Job
Contract No. QPA 13090 Phone 317-804-8035 Due Date
Fax 317-804-8037 03/09/2016
Sold To
Ship To -J
CARMEL STREET DEPT. Picked up at branch CY
3400 W 131 ST ST 1010 Kendall Court,Suite 3
WESTFIELD, IN 46074-8267 WESTFIELD, IN 46074
This Order and Document.is subject to the"Terms of Purchase"posted on www.fastenal.com.
Line Quantity Quantity Quantity Control Part Price/
No Ordered Shipped Backordered Description No. No. Hundred Amount
1 275 275 0 5/16-18 X 3 S/S HCS 120233981 1170065 40.5500 111.51 Y
Received By Tax Exemption Subtotal 111.51
0031201550-020 G Shipping&Handling 0.00
Comments IN State Tax 0.00
County Tax 0.00
Contact:Jim Bentley City Tax 0.00
Total 111.51
Reasonable collection and attorneys fees will be No materials accepted for return without our permission.
assessed to all accounts placed for collection. All discrepancies must be reported within 10 days.
If you re-package or re-sell this product,you are required to maintain Please pay from this invoice.
integrity of Country of Origin to the consumer of this product.
Invoice: ININ820920 Cust: ININ80003
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
02/08/16 ININ820920 $111.51
2201 201
1 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
Remit to INVOICE
FASTBIML Fastenal Company Page 1 of 1
P.O. Box 1286
Winona, MN 55987-1286 Invoice Date Invoice No.
01/20/2016 ININ820716
Cust.No. ININ80387 For billing questions
Cust. P.O. S15759 1010 Kendall Court, Suite 3 Invoice Total
Job No. WESTFIELD, IN 46074 65.87 USD
Contract No. QPA 13090 Phone 317-804-8035 Due Date
Fax .317-804-8037 02/19/2016
Sold To
0002851 01 AB 0.413 "AUTO T5 2 1006 46280-2-02651
Ship To
CARMEL WASTEWATER TREATMENT CARMEL WASTEWATER TREATMENT
9609 HAZEL DELL PKWY 9609 HAZEL DELL PKWY
INDIANAPOLIS, IN 46280-2935 INDIANAPOLIS, IN 46280-2935
This Order and Document is subject to the "Terms of Purchase" posted on www.fastenal.com.
Line Quantity Quantity Quantity Control Part Price/
No Ordered Shipped Backordered Description No. No. Hundred Amount
1 30 30 0 HCS 1/2-13 x 8 Z5 120231827 13229 201.6000 60.48 Y
2 60 60 0 USS F/W 1/2 Z 120168249 33012 8.9900 5.39 Y
Received By Tax Exemption Subtotal 65.87
0031201550-020 G Shipping&Handling 0.00
Comments IN State Tax 0.00
County Tax 0.00
Contact:Duane Jarvis City Tax 0.00
Total 65.87
Reasonable collection and attorneys fees will be No materials accepted for return without our permission.
assessed to all accounts placed for collection. All discrepancies must be reported within 10 days.
If you re-package or re-sell this product, you are required to maintain Please pay from this invoice.
integrity of Country of Origin to the consumer of this product.
0002851-01-0008655 Invoice: ININ820716 cust: ININ80387
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
92000
FASTENAL COMPANY Purchase Order No.
PO BOX 1286 - Terms
WINONA, MN 55987-1286 Due Date 2/3/2016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/3/2016 ININ820716 $65.87
hereby certify that the attached invoice(s), or bill(s) is (are)true and
;orrect and I have audited same in accordance with IC 5-11-10-1.6
Date Officer
INVOICE
Date: February 22, 2016
Sold to: City of Carmel Police Department
3 Civic Square
Carmel, IN 46032
Payment for annual FBI National Academy dues for the following people:
NAME
Timothy J.Green ID#6178
James Barlow ID#724
Leland Goodman ID#32876
David C. Strong ID#29938
Joseph E. Bickel ID#38967
Larry Collins ID#41829
Jeffrey Horner ID#36077
Dwight Frost ID#38213
Charles V. Harting ID# 19045
$80.00 x 9=$720.00
TOTAL DUE: $720.00
Please make check payable to:
FBINAA
Mail to:
Member Services
FBI National Academy Associates, Inc.
422 Garrisonville Road, Suite 103
Stafford, VA 22554
INVOICE
Date: February 22, 2016
Sold to: City of Carmel Police Department
3 Civic Square
Carmel, IN 46032
Payment for annual FBI National Academy dues for the following people:
NAME
Timothy J. Green ID#6178
James Barlow ID#724
Leland Goodman ID#32876
David C. Strong ID#29938
Joseph E. Bickel ID#38967
Larry Collins ID#41829
Jeffrey Horner ID#36077
Dwight Frost ID#38213
Charles V. Harting ID# 19045
$80.00 x 9=$720.00
TOTAL DUE: $720.00
Please make check payable to:
FBINAA
Mail to:
Member Services
FBI National Academy Associates, Inc.
422 Garrisonville Road, Suite 103
Stafford,VA 22554
Green, Timothy J
From: FBINAA Member Services <info@fbinaa.org>
Sent: Thursday,January 14, 2016 3:17 PM
To: Green,Timothy J
Subject: Your 2016 Membership Dues Notice
1
r
het _exH 41�
FBI National Academy Associates
Stafford, VA 22554
540-628-0834
Tax ID: 52-6080524
Invoice
2016 Dues Invoice
Member Name: Timothy J. Green
Member ID: 6178
Date:01/05/2014
Indiana Chapter 10.00
FBINAA National Dues 70.00
Grand Total 80.00
Thank you for being a member of the world's strongest law enforcement leadership network. Above
you will find an invoice for your 2016 membership dues. To avoid your membership being canceled,
your membership dues must be paid by March 31, 2016.
Dues can be paid online at www.fbinaa.org. You will need to log on to the Members Only section of
the website with your member number and the default password of your first and last name, all lower
case and no spaces.
You can also make checks payable, in US dollars, to FBINAA and forward to:
FBI National Academy Associates, Inc.
422 Garrisonville Rd., Ste. 103
Stafford, VA 22554
Thank you,
i
Young, Patricia A
Subject: FW:Your 2016 Membership Dues Notice
FBI National Academy Associates
Stafford, VA 22554
540-628-0834
Tax ID: 52-6080524
Invoice
2016 Dues Invoice
Member Name: James C. Barlow
Member ID: 724
Date:01/05/2014
Indiana Chapter 10.00
FBINAA National Dues 70.00
Grand Total 80.00
Thank you for being a member of the world's strongest law enforcement leadership network. Above
you will find an invoice for your 2016 membership dues. To avoid your membership being canceled,
your membership dues must be paid by March 31, 2016.
Dues can be paid online at www.fbinaa.org. You will need to log on to the Members Only section of
the website with your member number and the default password of your first and last name, all lower
case and no spaces.
You can also make checks payable, in US dollars, to FBINAA and forward to:
FBI National Academy Associates, Inc.
422 Garrisonville Rd., Ste. 103
Stafford, VA 22554
Thank you,
Jennifer Watson
i
Young, Patricia A
Subject: FW: Your 2016 Membership Dues Notice
FBI National Academy Associates
Stafford, VA 22554
540-628-0834
Tax ID: 52-6080524
Invoice
2016 Dues Invoice
Member Name: Leland Goodman
Member ID: 32876
Date:01/05/2014
Indiana Chapter 10.00
FBINAA National Dues 70.00
Grand Total 80.00
Thank you for being a member of the world's strongest law enforcement leadership network. Above
you will find an invoice for your 2016 membership dues. To avoid your membership being canceled,
your membership dues must be paid by March 31, 2016.
Dues can be paid online at www.fbinaa.org. You will need to log on to the Members Only section of
the website with your member number and the default password of your first and last name, all lower
case and no spaces.
You can also make checks payable, in US dollars, to FBINAA and forward to:
FBI National Academy Associates, Inc.
422 Garrisonville Rd., Ste. 103
Stafford, VA 22554
Thank you,
Jennifer Watson
Member Services Manager
FBINAA Executive Office
1
Strong,: David-.C. -
From: FBINAA Member Services <info@fbinaa.org>
Sent: Thursday,January 14, 2016.1:39 PM
To:.' Strong, David C
Subject: , . Your 2016 Membership Dues Notice .
Jo
FBI-National-Academy Associates
Stafford, VA_22554.
540=628-0834
Tax ID,-5276080524
Invoice
2016 Dues Invoice .
Member Name::.David.C..Strong_
Member ID: 29938
Date:01/05/2014
Indiana_Chapter: 10.00::
FBINAA National Dues . 70.00. .':
Grand Total 80.00
Thank you for being a-member of the world's strongest_lawenforcement leadership network. Above:
you will find an invoice for your 20.16 membership dues. To avoid your membership.being canceled,
your membership dues must be paid by.March:31;.'20.16:
Dues can be-paid online.at www:fbinaa.org. You will: need to log on to the Members Only section of
the website with your:member number and the default password of your.first and.last.name, all lower
case and no spaces.
You can also make checks payable, in US dollars, to FBINAA and forward.to:
FBI National Academy Associates; Inc.
422 Garrisonville Rd:., Ste. 103
Stafford, VA 22554
Thank you,
1
Young, Patricia A
Subject: FW: Your 2016 Membership Dues Notice
NA ��
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C v
FBI National Academy Associates
Stafford, VA 22554
540-628-0834
Tax ID: 52-6080524
Invoice
2016 Dues Invoice
Member Name: Joseph E. Bickel
Member ID: 38967
Date:01/05/2014
Indiana Chapter 10.00
FBINAA National Dues 70.00
Grand Total 80.00
Thank you for being a member of the world's strongest law enforcement leadership network. Above
you will find an invoice for your 2016 membership dues. To avoid your membership being canceled,
your membership dues must be paid by March 31, 2016.
Dues can be paid online at www.fbinaa.org. You will need to log on to the Members Only section of
the website with your member number and the default password of your first and last name, all lower
case and no spaces.
You can also make checks payable, in US dollars, to FBINAA and forward to:
FBI National Academy Associates, Inc.
422 Garrisonville Rd., Ste. 103
Stafford, VA 22554
Thank you,
Jennifer Watson
Member Services Manager
i
V
Ye �
FBI National Academy Associates
Stafford, VA 22554
540-628-0834
Tax ID: 52-6080524
Invoice
2016 Dues Invoice
Member Name: Larry Collins
Member ID: 41829
Date:01/05/2014
Indiana Chapter 10.00
FBINAA National Dues 70.00
Grand Total 80.00
Thank you for being a member of the world's strongest law enforcement leadership network.
Above you will find an invoice for your 2016 membership dues. To avoid your membership
being canceled, your membership dues must be paid by March 31, 2016.
Dues can be paid online at www.fbinaa.orQ. You will need to log on to the Members Only
section of the website with your member number and the default password of your first and
last name, all lower case and no spaces.
You can also make checks payable, in US dollars, to FBINAA and forward to:
FBI National Academy Associates, Inc.
422 Garrisonville Rd., Ste. 103
Stafford, VA 22554
Thank you,
Jennifer Watson
Member Services Manager
FBINAA Executive Office
Young, Patricia'A
Subject: FW:Your 2016 Membership Dues Notice
07
dba �r
FBI National Academy Associates
Stafford, VA 22554
540-628-0834
Tax ID: 52-6080524
Invoice
2016 Dues Invoice
Member Name: Jeffrey Horner
Member ID: 36077
Date:01/05/2014
Indiana Chapter 10.00
FBINAA National Dues 70.00
Grand Total 80.00
Thank you for being a member of the world's strongest law enforcement leadership network. Above
you will find an invoice for your 2016 membership dues. To avoid your membership being canceled,
your membership dues must be paid by March 31, 2016.
Dues can be paid online at www.fbinaa.ora. You will need to log on to the Members Only section of
the website with your member number and the default password of your first and last name, all lower
case and no spaces.
You can also make checks payable, in US dollars, to FBINAA and forward to: .
FBI National Academy Associates, Inc.
422 Garrisonville Rd., Ste. 103
Stafford, VA 22554
Thank you,
Jennifer Watson
. 1
Young, Patricia A
Subject: FW:Your 2016 Membership Dues Notice
FBI National Academy Associates
Stafford, VA 22554
540-628-0834
Tax ID: 52-6080524
Invoice
2016 Dues Invoice
Member Name: Dwight Frost
Member ID: 38213
Date:01/05/2014
Indiana Chapter 10.00
FBINAA National Dues 70.00
Grand Total 80.00
Thank you for being a member of the world's strongest law enforcement leadership network. Above
you will find an invoice for your 2016 membership dues. To avoid your membership being canceled,
your membership dues must be paid by March 31, 2016.
Dues can be paid online at www.fbinaa.org. You will need to log on to the Members Only section of
the website with your member number and the default password of your first and last name, all lower
case and no spaces.
You can also make checks payable, in US dollars, to FBINAA and forward to:
FBI National Academy Associates, Inc.
422 Garrisonville Rd., Ste. 103
Stafford, VA 22554
Thank you,
Jennifer Watson
Member Services Manager
FBINAA Executive Office
1
FBINAA 2016 Dues h
19045 Member
Product Taxable Value Balance
Indiana Chapter 10.00
FBINAA National Dues 70.00
Charles V. Harting Total 80.00
11955 E 166th St
Noblesville, IN 46060-9244
REMITTANCE STUB
(Please Return)
19045 Member Product Taxable Value Balance
Indiana Chapter 10.00 [ ]
Charles V. Harting FBINAA National Dues 70.00 [ ]
11955 E 166th St
Total 80.00
Noblesville, IN 46060-9244
Please return this stub with your payment to:
Member Services
FBI National Academy Associates
422 Garrisonville Rd, Suite 103
Stafford,VA 22554
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
02/22/16 0 annual membership dues $720.00
1110 101
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
Invoice Number Invoice Date Account Number Page
5-307-74806 Feb 03 2016 1062-2307-6 2of4
Adjustment Request
Fax to (800) 548-3020
Use this form to fax requests.for-adjustments due to the reasons indicated below. Requests for adjustments
due to other reasons, including.service failures,should.be submitted by going to www.fedex.com or calling
800.622.1147. Please use multiple forms for additional requests.
_..
1161
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Please complete all fields in black ink.
116ill Name l I I I I I I I I I I I I I I I I I I I I I I I I 'I I I Date W/ W/ 1 1 1
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ADR-Address Correction INW-Incorrect Weight OVS- Oversize Surcharge For all Service failures or other
o
DVC-Declared Value INS- Incorrect Service RSU- Residential Delivery surcharges please use our web
a IAN- Invalid Acct# OCF- Grd Pick-up Fee PND- Pwrshp Not Delivered site www.fedex.com or call
OCS-Exp Pick-up Fee SDR- Saturday Delivery (800)622-1147
Rerate information only (round to nearest inch)
Tracking Number Code $Amount LBS L W H
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5-307-74806 Feb 03 2016 1062-2307-6 3of4
FedEx Express Shipment Summary By Reference
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iternce _.. Inatges Charges Cretlits/Otlt larruutts OEM"
NO REFERENCE INFORMATION 1 1.0 2535 2535
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Total This Invoice USD WOU7
1033-01-00-0045419-0001-0100798.
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
vhom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
nvoice Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
02/19/16 5-307-74806 $25.75
1192 101
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
Fe&c. Invoice Number Invoice Date Account Number Page
5,-315-83280 Feb 10,2016 3134-0235-6 3 ot 4
FedEx Ground Shipment Summary By Payor Type
FedEx Ground Shipments(Original)
. . .......
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01/28 1 2 8.91 3.48 12.39
Ground-Prepaid Subtotal $12.39
.... .. .... .. ... . ......... .... ........ .... .. ...
...............................
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Total This Invoice USD $12.39
1040-01-00-0037079-0001-0085050
'rescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
kn invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by
vhom, rates per day, number of hours, rate per hour, number of units, price per unit,etc.
Payee
Purchase Order No.
Terms
Date Due
nvoice Date invoice# Description Amount.
Dept. Fund# (or note attached invoice(s)or bill(s))
02/10/16 I 5-315-83280 I I $12.39
1115 101
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
120-
Clerk-Treasurer
20Clerk-Treasurer
FERGUSON
ENTERINC."
PRISES, INVOICE NUMBER CUSTOMER , PAGE
0058518 3686 1 of 1
6439 EAST 30TH STREET PLEASE REFER TO INVOICE NUMBER WHEN
INDIANAPOLIS, IN 46219-0000 MAKING PAYMENT AND REMIT TO:
FERGUSON WATERWORKS#1934
PO BOX 644054
Please contact with Questions: 317-546-2013 PITTSBURGH, PA 15264-4054
SHIP TO:
1250 1 AB 0.416 E0024X 10037 D1627613398 P3097872 0001:0001
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CARMEL UTILITIES
3450 W 131 ST ST
CARMEL IN 46074-8267
SHIP SELL TAX CODE CUSTOMER ORDER NUMBER SALESMAN JOB NAME INVOICE DATE BATCH
_ WHSE. WHSE.
1934 2930 INE SMITTY '— —" -PLP -
--_ -BRASS-QUOTE-- ---02/05/16-- - 6307-9-- —
ORDERED s SHIPPED -' ITEM NUMBER DESCRIPTION s _ UNIT PRICE, UM AMOUNT
2 2 FY503 3/4 MTR YOKE BAR 17.080 EA 34.16
3 3 FC4433QNL LF 3/4 CTS X CTS QJ COMP COUP 13.400 EA 40.20
4 4 FBA94323WQNL LF 5/8X3/4 BA94-323W-Q-NL ANG BV 56.770 EA 227.08
1 1 FBA91323WNL LF 5/8X3/4 BA91-323W-NL ANG BV 77.000 EA 77.00
4 4 FBA94324WQNL LF 5/8X1 BA94-324W-Q-NL ANG BV 75.000 EA 300.00
INVOICE SUB-TOTAL 678.44
....................... .........................................................
LEAD LAW WARNING:IT IS ILLE AL TO INSTALL PROD CTS THAT ARE NOT"LEAD FREE"IN ACCORDANCE WITH
US FEDERAL OR OTHER APPLICABLE LAW IN POTABLE WATER SYSTEMS ANTICIPATED FOR HUMAN CONSUMPTION
PRODUCTS W TH'NP IN THE DE SCRIPTION ARE NOT LEAD FREE AND CAN ONLY BE INSTALLED IN
NON-POTABLE APPLICATIONS.13UYER IS SOLELY RESF ONSIBLE FOR PRODUCT SELECTION.
Thank you for your business
TERMS: NET 10TH PROX ORIGINAL INVOICE TOTAL DUE $678.44
All past due amounts are subject to a service charge of 1.5% per month, or the maximum allowed by law, if lower. If Buyer fails to
pay.within terms, then in addition to other remedies, Buyer agrees to pay Seller all costs of collection, including reasonable
attorney fees. Complete terms and conditions are available upon request or at http://wolseleyna.com/terms_conditionsSale.htmi
and are incorporated by reference. Seller may convert checks to ACH.
0001:0001
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
353162
FERGUSON WATERWORKS INDY#1934 Purchase Order No.
PO BOX 644054 Terms
PITTSBURGH, PA 15264-4054 Due Date 2/15/2016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/15/2016 0058518 $678.44
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
Date Officer