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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 ..