HomeMy WebLinkAbout321151 01/25/18 r
CITY OF CARMEL, INDIANA VENDOR: 367119ONE CIVIC SQUARE EVERGREEN MOUNTAIN, LLCCHECKAMOUNT: S*******675.00*
CARMEL, INDIANA 46032 PO BOX 1169 CHECK NUMBER: 321151
."ZTAOS NM 87571-1169 CHECK DATE: 01/25/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 101288 675.00 TRAINING SEMINAR
VOUCHER NO. WARRANT NO. Prescribed by State Board 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
101288 0 43-570.00 $675.00 1 hereby certify that the attached invoice(s),or 1/17/18 0 training-Dawson $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
Thursday,January 18,2018
8c'.., IE?3.A.w
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
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Evergreen Mountain, LLC .COURSE R
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PREFERRED ADDRESSCITY( /�„ STATE - ZIP CODE
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"PREFERRED TELEPHONENUMBER" PREFERRED E-MAIL ADDRESS
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GEHCY/BASE ADDRESS T�STATE ZIP CODE ~
of
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AGENCY/BASE TELEPHONE NUMB-ER - EXTENSION T?AGENCY/BASE A
E-MAIL ADDRESS
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Evergreen Mountain,LLCrequires.all non-DOD or Law Enforcement personnel to submit appropriate ID
ent drivers license.OR. ❑ Passport:OR LI.Any"current ID that proves US citizenship
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COURSEISEMINAR SELECTION: Price is per student
.. .. .. y .c'S�-`''yr.¢ 1Aa%Ia r'.1ar°�C:k =� �r�i°t.�R
Basic Night Vision Course .3 Da . "$6bo" Instru°ctor S oohouse;L Dal
6,115,
Ll Principles of Urban Conflict(3 Day)($6o0)(4 Day)($8o0) ❑Carbine/Pistol Course($zoo/day)
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.❑.Rural.Area.Sma11 Unit Tactus($zoo/day} ❑Sniper Course:($zoo/day)
El.Tactical Team Leader Course(5 Day)($a,000) ❑ Leadership Seminar($85)
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Q" ,COURSE_LOCATION COURSE DATE(S) - - -
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By signing•and submitting this registration form,:l understand:and agree to the following: :: n
. That.tfie credentials included:with this registration forth meet the regirirements.as speci fled:by Evergreeri Mountain,LLC,and
that i will be required to show proo f o f.identification on the first day Of the'course%seminar: -
Where applicable;.that Evergreen Mountain, LLC courses will depend upon the careful control of deadly Weapon(s) by me,.:
therefore I.under$tand.and agree that my participation may be terminated at any.time during.:the course if the staff/
Instructor deems my behavior,conduct orw.eapon handling skills to be unsatisfactory..-
That I will abide meticulously by any and all safety procedures as outlined and specified by"Evergreen-Mountaln,LLC and that'I
will agree to signing a,liability waiver form releasing Evergreen Mountain,LLC f rom any injury I may sustain during the course.
I understand.that my deposit is non-refundable and non-transferable. However,in the:case of an emergency, l understand
that Evergreen Mountain;LLC will work to provide a fair and equitable solution for both-parties.
..SIGNATURE •. DATE - -
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V V V
if paying by credit tard,:please complete the following: ,
." NAME As IT APPEARS ON CREDIT"CARD- .. .. AUTHORIZATION SIGNATURE .. j'DATE .. .
CREDIT CARD NUMBER., - - i EXPIRATION DATE j 3 DIGIT AUTHORIZATION CODE
C
IMPORTANT: Ycjur:credit"card will be charged the day your registration form is.received. Please include the bill= ..
Ing address where the.monthly statement'is"sent.
.. ADDRESS- .. —ICrtY STATE ZIP CODE
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PLEASE MAKE CHECKIMONEY ORDER PAYA13LE TO:EVERGREEN MOUNTAIN, LLC
SCAN
• EMAIL REGISTRATION •• i COPY OF • • TO: ROB@EVERGREENMOUNTAINUSA.COM
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EVERGREEN • A Box 116q TAos, • i / • -
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