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HomeMy WebLinkAbout258099 04/29/16 a°�"FQa'M q;/ �"� CITY OF CARMEL, INDIANA VENDOR: 364188 ® I ONE CIVIC SQUARE AMERICAN PUBLIC WORKS ASSOCIATI@NECK AMOUNT: $....*1,200.00* a9� ,: CARMEL, INDIANA 46032 PO BOX 801753 CHECK NUMBER: 258099 .y��TON.�,, KANSAS CITY MO 64180.1753 CHECK DATE: 04/29/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4343002 33506 042716 1,200.00 SNOW CONFERENCE VOUCHER NO. WARRANT NO. ALLOWED zo Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995) AMERICAN PUBLIC WORKS ASSOCIATION IN SUM OF$ CITY OF CARMEL PO BOX 802296 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service rendered,by KANSAS CITY,MO 64180-2296 whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $1,200.00 Payee Purchase Order No. ON ACCOUNT OF APPROPRIATION FOR Terms Street Department Date Due Invoice Date Invoice# Description Amount PO#/Dept. INVOICE NO. I ACCT#/Fund AMOUNT Board Members Dept. Fund# (or note attached invoice(s)or bill(s)) 33506 I 0 I 43-430.02 I $1,200.00 1 hereby certify that the attached invoice(s),or 04/26/160 $1,200.00 2201 201 2201 201 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 Tuesday A ril26 0 lt Stmet C`nmmiscir)nPr Cost distribution ledger classification if I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance claim paid motor vehicle highway fund with IC 5-11-10-1.6 ,20_ Clerk-Treasurer • �11 c sno c S H' O L.L_ 2016 AP1m AMOPICan Snow COnFOPBACO snow a ice ManaHmeni; MaY 22-25, 2016 1 conneccim convemon : 1 OD BY GHO APWA NeW EnGLanD i ReGISHP eeF® re APPIL 1. 5 ano save $ 50 Ofl .e FULL ReGlKrRlon ATTENDEE REGISTRATION: Register online: www.apwa.net/snow REGISTRATION INFORMATION See the registration form for individual categories and Special Needs Register Online at www.apviiametisnow rates. If your employer has an APWA group membership, If you need special services or equipment,pursuant to the please note that individuals must be listed on your Americans with Disabilities Act(ADA)please contact the APWA Full Registration includes entrance into the exhibit hall,all group roster to receive the member registration rates. Meetings Department at 816-472-6100 or snow@apwa.net Education sessions,Sunday reception on the exhibit floor, PARTICIPANT AGREEMENT FOR THE 2016 APWA NORTH Assumption of Risk,Liability Waiver and Release and Monday and Tuesday lunch on the exhibit floor,refreshment AMERICAN SNOW CONFERENCE: Indemnity breaks,the Tuesday Snow Celebration,and the Wednesday In consideration of being allowed to participate in the APWA morning technical tour program. Cancellation Policy North American Snow Conference,including any related events, One-Day Registrations are available for Sunday,Monday A full refund will be granted if a written cancellation request is tours and activities(collectively the"APWA Snow Conference'),I orTuesday,and include entrance into the exhibit hall and all received no later than April 15,2016.Cancellations received after acknowledge that I am voluntarily undertaking participation in the education sessions.Sunday includes the reception on the exhibit April 15 but prior to May 22,2016 will be subject to a$75 USD APWA Snow Conference and by doing so I agree to observe and floor.Monday and Tuesday include lunch.Tuesday does not include cancellation fee.All payments will be forfeited when the written obey all posted rules,regulations and warnings;assume all risk the Snow Celebration,but you may purchase a ticket. cancellation request is received after May 21,2016 or in the event and take full responsibility for my own well-being.I am fully aware the participant is considered a"no-show". Non-attendance that possible property damage,physical injury,illness or death may You must have a full registration to participate in the does not excuse the participant from his/her financial obligation occur as a result of my participation in these events and activities. Wednesday technical tour program. to pay the fees due to APWA.APWA reserves the right to pursue I forever release the APWA,its directors,officers,employees, any and all collection efforts and practices including referring the volunteers,agents,contractors,and representatives(collectively You must have a full registration or Sunday one-day accouht to a collection agency and/or attorney and reporting to "Releases")from any and all actions,claims,or demands that 1,my registration to participate in the Winter Maintenance credit bureaus.The participant is responsible for collection agency family or heirs now have or may have in the future related to my Supervisor Certificate Workshop. fees,reasonable attomey`s fees,court costs and all other charges participation in these activities. Further,I agree to take full legal allowed by law. and financial responsibility for damage to personal property or the Expo Only Passes do not include lunch Monday or Tuesday. facilities utilized during the APWA Snow Conference or injury to Photo and Video Release another(including death)caused by my own negligent,reckless or Guest/Spouse Registrations are available at a special price,but I grant to APWA the right to take photographs or video of me in willful actions. I understand any legal or equitable claim that may not included s the registration form. a fablGuee at a special Registration connection with the APWA North American Snow Conference.I arise from my participation in the APWA Snow Conference shall be includes the Sunday reception on the exhibit floor,entrance into authorize APWA,its assigns and transferees to copyright,use and resolved under Connecticut law. the exec the hall on Monday and Tuesday,and the Tuesday evening publish the same.in print or electronically. I agree that APWA may Snow Celebration.If you are interested is registering your spouse use or reproduce such photographs with or without my name or By registering for the APWA Snow Conference,I acknowledge that I ora guest,please contact the APWA Meetings Department at use biography and for any lawful purpose,including APWA educational, have read,understand and agree to these terms and I am entering 472 6100 or email snow@apwa.net.th wa.net. news or promotional material,whether in print,electronic or other into this agreement of my own free will. media,including the APWA website. ATTENDEE PRE-REGISTRATION FORM COMPLETE BOTH SIDES AND ALL 4 SECTIONS OF THIN FORM TO REGISTER After May 18,2016,please register onsite at the Snow Conference. 1-REGISTRAN 1 ORMATION lumc lj qn0�tf L Name(one registrant per form) APWA Membership ID#(ca118 0-848-APWAto o tain your#) Nickname(for badge) sit, - omrn�5���ne� 1 Title Organization 3�ICb W • 5�5� Street Address City State/Province Zip/Postal Code 317--]-�3 311 vL tj-6mt� dhAW1AUM6. 6V Work Phone Numb r n(� Cell Phone Number Email lf, n Emergency Contact(someone not traveling with you) Emergency Contact Phone Number/Emergency Email 2-REGISTRATION TYPE Full Registration:(all prices US dollars) '-p BEFOREAPRICI5 JAFTERAPRIL,15 '; • ,APWA Member Full Registration(member price subject to member status verification) $500 $550 [� El APWA Member Full Registration including Winter Maintenance Supervisor Certificate Workshop $600 $650 El Nonmember Full Registration $700 $750 ElNonmember Full Registration including Winter Maintenance Supervisor Certificate Workshop $850 $900 ❑Please apply$184 of my nonmember registration fee to a one-year APWA individual membership.Offer extended to new APWA members only. • - •. APWA MEMBERNONMEMBERSUBTOTAL ❑Sunday One-Day Registration $225 $300 ❑Sunday One-Day Registration including Winter Maintenance Supervisor Certificate Workshop $325 $450 ❑Monday One-Day Registration $225 $300 1.❑Tuesday One-Day Registration(does not include Snow Celebration) 1 $225 $300 pleaseThe Wednesday Technical Tour is included with Full Registrations on ly.If you have a Full Registration select the tour you will.- ❑State and Municipal Emergency Winter Operations No,I will not be participating in the Technical Tour Expo• SUBTOTAL ❑Sunday Expo Only Pass $50 $50 ❑Monday Expo Only Pass $35 $35 ❑Tuesday Expo Only Pass $35 $35 Snow Celebration Reception(included in full registration only) Quantity: $50 each TOTAL AMOUNT DUE $ 3-DEMOGRAPHIC INFORMATION What type of organization/ What is the population of your What best describes your M oth r re po ibili'es incl de: What other conferences do �a9ency do you work for? agency's jurisdiction? rchase authority? �� ( , you atte c CSI City/TownshipNil[age ❑ 0—25,000 1 am the decision maker L� ❑ County ❑ 26,000-50,000 ❑ I influence the decision ❑ State/Province 51,000—100,000 ❑ I recommend what to LN'C�Uy ❑ Federal 101,000—250,000 purchase ❑ Private Contractor ❑ 251,000—1,000,000 ❑ I am not a part of _4 G rv1 ❑ Manufacturer/Supplier ❑ More than 1 million purchasing decisions How many APWA Snow ❑ Airport Authority Conferences have you attended? How do you plan to travel to the ❑ Other What best describes your title/job What percentage of your job is ❑ This is my first Snow Snow Conference? responsibilities? related to snow fighting? Conference Air Travel What is your agency's annual ❑ Supervisor ❑ 1-10% 2'— El Drive less than 50 miles budget? El Superintendent El11—25% n 4-7 ❑ Drive 51—100 miles ❑ Lessthan 1 million -Q' Division/Department Head ❑ 26-40% ❑ 8-10 ❑ Drive 101—250 miles ❑ 1-10 million ❑ Public Works Director 41-60% ❑ More than 10 ❑ Drive 251—500 miles 0 11—25 million ❑ Operations Manager N 61-75% ❑ Drive more than 500 miles ❑ 26—50 million ❑ Fleet Manager ❑ 76-90% How many conferences do you ❑ Don't know ❑ Operator ❑ More than 90% attend each year? ❑ Other ❑ Snow and ice is all I do. ❑ 1 ❑ 2 193 ❑ More than 3 4-PAYMENT INFORMATION TOTAL:$ (Fees are in US Funds.) MAIL ❑Check# enclosed(Made ayabl to APWA) completed registration form with check payment to: %Government Voucher or Purchase Order# 35�f\1 (Please attach copy of P.O.) American Public Works Association ❑Credit Card(check one): ❑Visa ❑MasterCard ❑American Express PO Box 801753•Kansas City,MO 64180-1753 YOUR CREDIT CARD WILL BE CHARGED IMMEDIATELY. OR FAX or EMAIL Card Number Expiration Date Credit card payments and P.O.Payments(with a copy of the P.O.) to:817-277-7616 or webreg@signup-confirmation.com Name as it appears on the card APWXs Federal ID#is 36-220-2880. QUESTIONS?Call APWA Registration at 817-277-7187 or Signature(required) email webreg@signup-confirmation.com CANCELLATION POLICY A full refund will be granted if a written cancellation request is received before or on April 15,2016.Cancellations made after April 15 and before May 22 will be subject to a$75 cancellation fee.All payments will be forfeited if registration is canceled on or after May 22,2016.No refunds will be granted for"no-shows."Non-attendance does not excuse the participant's financial obligation to pay the registration fees due to APWA.Accounts left unpaid for more than 90 days may be subject to further collection efforts.The participant will be responsible for any costs or expenses associated with collections including collection agency fees. SPECIAL NEEDS If you need special services or equipment,pursuant to the Americans with Disabilities Act,please contact APWXs Meetings Department at 816-472-6100 or email snow@apwa.net. • SNi ReGISEOr BBF0r0 APPIL 15 ano save s5o 00 8 FULL ReGlKrKl00 ATTENDEE REGISTRATION: Register online: .apwa.net/snow REGISTRATION INFORMATION See the registration form for individual categories and Special Needs Register Online at www.apwa.net/snow rates. If your employer has an APWA group membership, If you need special services or equipment,pursuant to the please note that individuals must be listed on your Americans with Disabilities Act(ADA)please contact the APWA Full Registration includes entrance into the exhibit hall,all group roster to receive the member registration rates. Meetings Department at 816-472-6100 or snow@apwa.net education sessions,Sunday reception on the exhibit floor, PARTICIPANT AGREEMENT FOR THE 2016 APWA NORTH Assumption of Risk,Liability Waiver and Release and Monday and Tuesday lunch on the exhibit floor,refreshment AMERICAN SNOW CONFERENCE: Indemnity breaks,theTuesday Snow Celebration,and the Wednesday In consideration of being allowed to participate in the APWA morning technical tour program. Cancellation Policy North American Snow Conference,including any related events, One-Day Registrations are available for Sunday,Monday A full refund will be granted if a written cancellation request is tours and activities(collectively the"APWA Snow Conference"),I ll acid all received no later than April 15,2016.Cancellations received after acknowledge that I am voluntarily undertaking participation in the orTuesday,and include entrance into the exhibit ha education sessions.Sunday includes the reception ll the exhihit April 15 but prior to May 22,2016 will be subject to a$75 USD APWA Snow Conference and by doing so I agree to observe and floor.Monday and Tuesday include lunch.Tuesday does not include cancellation fee.All payments will he forfeited when the written obey all posted rules,regulations and warnings;assume all risk the Snow Celebration,but you may purchase a ticket. cancellation request is received after May 21,2016 or in the event and take full responsibility for my own well-being.I am fully aware the participant is considered a"no-show". Non-attendance that possible property damage,physical injury,illness or death may You must have a full registration to participate in the does not excuse the participant from his/her financial obligation occur as a result of my participation in these events and activities. Wednesday technical tour program. to pay the fees due to APWA.APWA reserves the right to pursue I forever release the APWA,its directors,officers,employees, any and all collection efforts and practices including referring the volunteers,agents,contractors,and representatives(collectively You must have a full registration or Sunday one-day account to a collection agency and/or attorney and reporting to "Releases')from any and all actions,claims,or demands that I,my registration to participate in the Winter Maintenance credit bureaus.The participant is responsible for collection agency familyor heirs now have or may have in the future related to my Supervisor Certificate Workshop. fees,reasonable attorney's fees,court costs and all other charges participation in these activities.Further,I agree to take full legal allowed by law and financial responsibility for damage to personal property or the Expo Only Passes do not include lunch Monday orTuesday. facilities utilized during the APWA Snow Conference or injury to Photo and Video Release another(including death)caused by my own negligent,reckless or GuestlSpouse Registrations are available at a special price,but I grant to APWA the right to take photographs or video of me in willful actions.I understand any legal or equitable claim that may not included s the registration form. a Guest/Spouse Registration connection with the APWA North American Snow Conference I arise from my participation in the APWA Snow Conference shall be authorize APWA,its assigns and transferees to copyright,use and resolved under Connecticut law. includes the Sunday reception on the exhibit floor,entrance into the exhibit hall on Monday and Tuesday,and the Tuesday evening publish the same in print or electronically. I agree that APWA may Snow Celebration.If you are interested in registering your spouse use or reproduce such photographs with or without my name or By registering for the APWA Snow Conference,I acknowledge that I ora guest,please contact the APWA Meetings Department at use biography and for any lawful purpose,including APWA educational, have read,understand and agree to these terms and I am entering 472 6100 or email snow t the APnet, news or promotional material,whether in print,electronic or other into this agreement of my own free will. media,including the APWA website. ATTENDEE PRE-REGISTRATION FORM COMPLETE B®TH SIDES AND ALL 4 SECTI(I OF THIS FORM TO REMSTER After May 18,2016,please register onsite at the Snow Conference. I-REGISTRANT INFORMATION QOY-\ \, I j I am!� Name(one registrant per form) APWA Membership ID#(call 800-848-APWA to obtain your#) Nickname(for badge) Title Organization 3L..00 U. I3lsk S� . Street Address &Cmo_,1 74 City State/Province Zip/Postal Code 311✓� y aOO 4 SAP i1 r 01,Ylr S CO- Work Phone Number Cell Phone Numhp� Email !„Y, r ', , UV Emergency Contact(someone not traveling with you) Emergency Contact Phone Number/Emergency Email 2-REGISTRATION TYPE Registration:Full `BEFORE APRIL ISAFTERAPIL15 • ❑APWA Member Full Registration(member price subject to member status verification) $500 Y $550 ❑l APWA Member Full Registration including Winter Maintenance Supervisor Certificate Workshop $600 $650 Monmember Full Registration $700 $750 1 Cow ❑Nonmember Full Registration including Winter Maintenance Supervisor Certificate Workshop $850 $900 ❑Please apply$184 of my nonmember registration fee to a one-year APWA individual membership.Offer extended to new APWA members only. • • - •• e z. ❑Sunday One-Day Registration $225 $300 ❑Sunday One-Day Registration including Winter Maintenance Supervisor Certificate Workshop $325 $450 ❑Monday One-Day Registration $225 $300 ❑Tuesday One-Day Registration(does not include Snow Celebration) $225 $300 ❑State and Municipal Emergency Winter Operations No,I will not be participating in.the Technical Tour .. e • ❑Sunday Expo Only Pass $50 $50 ❑Monday Expo Only Pass $35 $35 ❑Tuesday Expo Only Pass $35 $35 Snow Celebration Reception(included in full registration only) Quantity: $50 each TOTAL AMOUNT DUE $ `l 660,6D 3-DEMOGRAPHIC INFORMATION What type of organization/ What is the population of your What best describes your My other responsibilities include: What other conferences do agency do you work for? agency's jurisdiction7 purchase authority? you attend? Vk CitylrownshipNil[age ❑ 0-25,000 ❑ I am the decision maker ❑ County ❑, 26,000-50,000 ❑ 1 influence the decision ❑ State/Province 51,000—100,000 1 recommend what to ❑ Federal ❑ 101,000-250,000 purchase ❑ Private Contractor ❑ 251,000—1,000,000 ❑ 1 am not a part of ❑ Manufacturer/Supplier ❑ More than 1million purchasing decisions How many APWA Snow ❑ Airport Authority Copferences have you attended? How do you plan to travel to the ❑ Other What best describes your title/job What percentage of your job is � This is my first Snow 411 w Conference? responsibilities? related to snow fighting? Conference Air TravelWhat is your agency's annual ElSupervisor 111-10% ❑ 2-3 Drive less than 50 miles budget? ❑ Superintendent ❑ 11-25% ❑ 4-7 ❑ Drive 51-100 miles ❑' Less than 1 million ❑ Division/Department Head ft 26-40% ❑ 8-10 ❑ Drive 101—250 miles ❑ 1-10 million ❑ Public Works Director U4 41-60% ❑ More than 10 ❑ Drive 251-500 miles ❑ 11—25 million ❑ Operations Manager ❑ 61-75% ❑ Drive more than 500 miles ❑ 26—50 million ❑ Fleet Manager ❑ 76-90% How many conferences do you Don't know ❑ Operatop- ❑ More than 90% attend each year? Other VOMYUN ❑ Snow and ice is all I do. ❑ 1 ❑ 2 E3 More than 3 4-PAYMENT INFORMATION TOTAL:$ (Fees are in US Funds.) MAIL Check# enclosed(Mc3de payable to APWA) completed registration form with check payment to: Government Voucher or Purchase Order# .S��L+ (Please attach copy of P.O.) American Public Works Association ❑Credit Card(check one): ❑Visa E]MasterCard E]American Express PO Box 801753 Kansas City,MO 64180-1753 YOUR CREDIT CARD WILL BE CHARGED IMMEDIATELY. OR FAX or EMAIL Card Number Expiration Date Credit card payments and P.O.Payments(with a copy of the P.O.) to:817-277-7616 or webreg@signup-confirmation.com Name as R appears on the card APWXs Federal ID#is 36-220-2880. QUESTIONS?Call APWA Registration at 817-277-7187 or Signature(required) email webreg@signup-confirmation.com CANCELLATION POLICY A full refund will be granted if a written cancellation request is received before or on April 15,2016.Cancellations made after April 15 and before May 22 will be subject to a$75 cancellation fee.All payments will be forfeited if registration is canceled on or after May 22,2016.No refunds will be granted for"no-shows."Non-attendance does not excuse the participant's financial obligation to pay the registration fees due to APWA.Accounts left unpaid for mote than 90 days may be subject to further collection efforts.The participant will be responsible for any costs or expenses associated with collections including collection agency fees. SPECIAL NEEDS If you need special services or equipment,pursuant to the Americans with Disabilities Act,please contact APWAs Meetings Department at 816-472-6100 or email snow@apwa.net.