HomeMy WebLinkAbout320431 01/11/18 -
,y�.... CITY OF CARMEL, INDIANA VENDOR: 367119
ONE CIVIC SQUARE EVERGREEN MOUNTAIN, LLC CHECK AMOUNT: $*******675.00*
s ,a4 CARMEL, INDIANA 46032 PO BOX 1169 CHECK NUMBER: 320431
9 TAOS NM 87571-1169 CHECK DATE: 01/11/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 101235 675.00 TRAINING
VOUCHER NO. WARRANT NO. Prescribed by State Hoard of Accounts City Form No.201(Rev.1995)
Vendor# 367119 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
EVERGREEN MOUNTAIN, LLC IN SUM OF$ CITY OF CARMEL
PO BOX 1169 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.
TAOS, NM 87571-1169
Payee
$675.00
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
101235 0 43-570.00 $675.00 I hereby certify that the attached invoice(s),or 1/5/18 0 training-Fisher $675.00
1110 210 1110 210
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
Monday,January 8,2018
& ? e-t�
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
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
EGM
' Evergreen Mountain;LLC . COURSE REGISTRTION
NAME
C PATION� � RANR/ASSIGNMENT/TITLE
Law Enforcement OMilitary DOther
PREFERRED ADDRESS : 'CITY -- STATE ZIP CODE -- -
'C: ✓� c . . S lit►9 -
o 3
PREFERRED TELEPHONE NUMBER . �' 'I PREFERRED E-MAIL ADDRESS - -- - -
.. . . ..AGENCY/BASE ADDRESS ,. .. CITY. - .. . - �STATE. ZIP CODE - ..
CA 2 rhe(
T41 Q 1 .� F CA,rfy^-e,
AGENCY/BASE TELEPHONE NUMBER f EXTENSION .AGENCY/BASE E-MAIL ADDRESS -
30,-s_.�
Evergreen'Mountain,LLC requires all non-DOD or Law Enforcement personnel to submit appropriate-ID
Current drivers.license OR ❑.Passport.OR 0,Any:current ID that proves US citizenship
COURSE/SEMINAR SELECTION: Price is per student:
tudent
❑Basic Night Vision Course(3 Da )($6o6) ❑ Instructor SfioothouS. (3 66y)($600). .: .
W _ _
❑:Principles Of Urban Conflict(3 Day)($66o)(4 Day)($860) 0 Carbine/Pistol.Course($zoo%day)
O.Rueal Area Small Unit Tactics($zoo/day) 0 Sniper.Course($26o/clay)
Tactical Team Leader Course y)(p ❑ "Leadership Seminar($85) a.
Q COURSE.LOCATION. _- .COURSE DATES - .
�7 ..v
BY si nin and submittin this re istration:fora understand and a ree tothe folloWin
9 9 . 9. form,.. g , 9:
Q That the credentials included.with this registration form,meet the requirements as specified by Evergreen Mountain,LLC,and
that_I will be required to show proof of identi fication.on the first day of the course/seminar. . '
-Where applicable,that Evergreen Mountain,LLC courses will depend upon the'careful control of deadly weapons)by me;
therefore I understand and agree that my participation may be terminated at any time during the course if the staff/.
instructor deems my'behavior,conduct or weapon handling skills to.be unsatis factory. .
That l will.abide.me.ticulously.by any and all sa fety procedures as outlined and specified by Evergreen Mountain,LLC and that 1
will agree to:signing a liability waiver form releasing Evergreen Mountain,LLC.from any injury I may sustain during the course. �t
I understand that my deposit.is.non-.refundable and non-transferable. However,in:the case of an emergency,l understand
..
that rgr en Mountain,kCC will work to provide'a fair and equitablesolution for both parties.: .
/ZI 11.2017
.. SIGNATURE. '" .. .. - DATE. - .. ..
If paying by credit.card,please complete the following: wsccv�rT
0 VISA
NAME AS R APPEARS ON CREDIT CARDAUTHORIZATION SIGNATURE— DATE
: .
CREDIT CARD NUMBER :. .- .
3 DIGIT AUTHORIZATON CODE
. F]�IRATION DATE .. .
l
IMPORTANT: Your credit card_will be charged the day your registration form is received."Please include the bill
ing address where the,mohthly statement is sent.
ADDRESS CITY _ STATE _ ZIP CODE .
Ir
PLEASE MAKE CHECKIMONEY ORDER PAYABLE TO:EVERGREEN MOUNTAIN, LLC
SCAN
/ EMAIL REGISTRATION •' i COPY OF / • TO: ROB@EVERGREENMOUNTAINUSA.COM
OR MAIL REGISTRATION FORM, COPY OF IDENTIFICATION,AND PAYMENT TO:
. EVERGREEN MOUNTAIN, P.O. Box 116q TAos, • 8 •9 ..