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HomeMy WebLinkAbout319947 12/21/17 abiuf�aq,,f. CITY OF CARMEL, INDIANA VENDOR: 00352252 CHECK AMOUNT: $*******'75.00' d zl ONE CIVIC SQUARE IPMBA r4 CARMEL, INDIANA 46032 583 FREDERICK RD SUITE 58 CHECK NUMBER: 319947 BALTIMORE MD 21228 CHECK DATE: 12/21/17 t tON� DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4355300 75.00 ORGANIZATION & MEMBER VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER Vendor# 00352252 --IPMBA IN SUM OF$ 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. BALTIMORE, Mp�,Zt22 ;4 ,: Payee $75.00 ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Carmel Police Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 0 43-553.00 $75.00 1 hereby certify that the attached invoice(s),or 12/18/17 0 annual membership-Schoeff $75.00 1110 101 1110 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 Wednesday, December 20,2017 Jim Barlow Chief 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer IPMBA MEMBERSHIP AND CERTIFICATION APPLICATION IPMBA Membership and Certification reduces liability and helps you stay safeand effective on the job BENEFITS INCLUDE: • Internationally recognized IPMBA Police,EMS or Security Cyclist Certificate... V • IPMBA News(training tips,product reviews,funding information,and resources)... • Subscription to Bicycling*Magazine... • Discounted registration to IPMBA's Annual Conference... • Access to advanced training opportunities,including the IPMBA Instructor Course... • Members-only discounts on equipment and gear... • IPMBA member decals! (*A$10.00 value,U.S.addresses only.). Name D.J.Schoeff Police m EMS❑ Security❑ IPMBA certification is available Home Address 14 Beechmont Drive to members only. City Carmel State IN Zip/Country 46032 IPMBA membership is open to individuals only. Home Phone( ) Mobile( 317 ) 697-9502 ahoo.com Membership materials will be d—schoeff@yahoo.com E-Mail Address coy mailed to your home address. Department E-Mail Address dschoeff@carmel.in.gov (Allow 6-8 weeks) Department Carmel Police Department Please mail applications and Department Address 3 Civic Square payment immediately following City Carmel State IN Zip/Country 46032 the course. Dept.Phone( 317 ) 571-2500 Dept.Fax ( ) Membership Number(for current IPMBA members) I have successfully completed the following IPMBA Course(check one),scoring at I 1 least 76%on the written test and passing the practical skills tests. �� . 'ice F •-�.. m Police Cyclist Course ❑EMS Cyclist Course 13 Security Cyclist Course S Ba ti r D Primary IPMBA Instructor's Name: 1228 Instructor Number: -or- Dates of the Course: Month Dates Year Location of Course: Fax credit card info to: (Facility Name,City,and State) 410-744-5504 1 would like to become an IPMBA-Certified PAYMENT METHOD(U.S.FUNDS ONLY) Police, EMS, or Security Cyclist and join ❑ Check or money order(payable to IPMBA) IPMBA's Registry of Certified Public Safety ❑ Visa ❑ MasterCard (select one) Cyclists. Name on Credit Card(please print): El $75.00 IPMBA Certification(includes Email Address of Card Holder: one year of membership) Credit Card Number: ❑ $ 5.00 Police Cyclist Pin(❑gold or❑silver) Expiration: / Code: ❑ $ 5.00 EMS Cyclist Pin(gold only) Signature: ❑ $ 5.00 Security Cyclist Pin(silver Billing Address: ❑ Home JW Department only) $ 75.00 TOTAL Purchase orders accepted for multiple memberships only. Federal Tax ID:52-2137781 ©2016 International Police Mountain Bike Association•www.ipmba.org Reset Form I