HomeMy WebLinkAbout320716 01/11/18 .Gqq
CITY OF CARMEL, INDIANA VENDOR; 00352482 CHECK AMOUNT: $********90.00*
�b ONE CIVIC SQUARE IMPACT
`a? CARMEL, INDIANA 46032 125 W MARKET STREET STE 240 CHECK NUMBER: 320716
INDIANAPOLIS IN 46204-2882 CHECK DATE: 01/11/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4355300 010918L 50.00 ORGANIZATION & MEMBER
1201 4355300 010918S 20.00 ORGANIZATION & MEMBER
1201 4355300 010918W 20.00 ORGANIZATION & MEMBER
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 00352482 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IMPACT IN SUM OF$ CITY OF CARMEL
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125 W MARKET STREET STE 09 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.
INDIANAPOLIS, IN 46204-2882
Payee
$90.00
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Human Resources 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
01.09.18-S 43-553.00 $20.00 1 hereby certify that the attached invoice(s),or 1/9/18 01.09.18-S J Spelbring Dues $20.00
1201 101 1201 101
01.09.18-W 43-553.00 $20.00 bill(s)is(are)true and correct and that the 1/9/18 01.09.18-W S Wolfgang Dues $20.00
1201 101 1 materials or services itemized thereon for 1201 101
I 01.09.18-L I 43-553.00 I $50.00 1/9/18 01.09.18-L B Lamb 2018 Dues $50.00
1201 101 which charge is made were ordered and 1201 11
received except
Tuesday,January 09,2018
Lamb, Barbara
Director
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
II II
pnc 2018 IMPACT Dues enc
OF
❑ Primary Member-$50.00(First-person from a Municipality)
Name: Title:
Title:
Municipality:
Address:
City: State: Zip:
Phone: Fax:
Email:
�] Secondary Member-$20.00(Each additional person from a Municipality)
Name: 598_L53k1/J G Title:, AbN�••,�S t��-rz ,
Title: ln-rte.-' 2-�3ou rz-�3
Municipality: C( r (-L
Address: [ (2-14 Ute, Sl�.v
City: Gly State: /A/ Zip: Lf 603 'Z-
Phone:
Phone: Y7 --,17/ Nl4 ? Fax:_ 3 1-2-5-71- ;zqo S
Email: ()L,-1_i32tti CA4k-m�2 • -_*j-
❑ Associate:Membership-$100.00 �, a{
Name: Title: ` ubm4_."te d To
Title:
Company: JAN 1 i 1 2 18
Address:
City: State: Zigi �" �
Phone: Fax:
Email:
Mail completed forms andpayments no later than May 31,2018 to:
Aim, 125 W. Market Street,Suite 100, Indianapolis, IN 46204
Paying By: IMPACT accepts the following credit cards(Please complete the following)
❑Check# ❑American Express.❑Discover ❑MasterCard ❑Visa Amount:
(Payable to Aim) Card Number:
Expiration Date: Verification Code:
❑Credit Card Name on Credit Card:
Billing Address:
Signature:
PACPAC
2018 IMPACT Dues
if Primary Member-$50.00(First person from a Municipality)(I
Name.&-K`04,9 4 1-aM 3 Title: `0 Q 2 c e FD O f (-tvvharn��c3u� ce3
Title:
Municipality: {y4 crF CA-e,-Y\-c---L
Address: 1 C_c v t SCS V"-Q-G-'
City: QJ�LZ- State• Zip: 46-032-
Phone:
6-032Phone: 3 1-?-57 /-;Z q? Fax:. 31-7-5-'7/- 2-cf0 5
Email 3 C-Ai2-M.L -, nj G o V
9 Secondary-Member-$20.00(Each additional person from a Municipality)
Name:-UIQ U)dWqCkry:�, Title:
Title:
Municipality: U C5-F 0'"yn
Address: I CW1( SQ UJ-t� R
U
City: &('Y`f1 o StateN Zip: a
Phone:30-15171-5 RSO Fax:3n- 5-7 aL1 p2
Email:
❑ Associate Membership:-$100.00 S;ub ;n7- tIT
Name: Title:
Title:Company:
Address: Cr
City: Stat nZ
Phone: Fax:
Email:
Mail completed forms and payments no later than May 31,2018 to:
Aim, 125 W. Market Street,Suite 100,_Indianapolis, IN 46204
Paying'By: IMPACT accepts the following credit cards(Please complete the following)
❑Check# ❑American Express ❑Discover ❑MasterCard ❑Visa Amount:
(Payable to Aim) Card Number:
Expiration Date: Verification Code:
❑Credit Card Name on Credit Card
Billing Address:
.Signature: