182000 02/03/2010 7 F CITY OF CARMEL, INDIANA VENDOR: 360710 Page 1 of 1
4 i ONE CIVIC SQUARE LIFESAVERS CONFERENCE INC CHECK AMOUNT: $275.00 iii A CARMEL, INDIANA 46032 PO BOX 30045
1; ALEXANDRIA VA 22310
4: Z.t. CHECK NUMBER: 182000
CHECK DATE: 2/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 21313 275.00 TRAINING
-rte
LIFESAVERS
lwlk �y� i �M
NATIONAL CONFERENCE ON HIGHWAY SAFETY PRIORITIES
i
INVOICE CO
agallagher@carmel.in.gov; r1��
January 18, 2010
Ann Gallagher
Carmel Police Dept.
3 Civic Square
Carmel, IN 46032
As of today,- indicate a balance due for fees. If you have recently made a payment and feel it may
have crossed in the mail, please disregard this invoice. For questions, please phone (304) 724 -3006. Please remit
payment to:
Lifesavers Conference
PO Box 30045
Alexandria, VA 22310
ATTN: Accounts Receivable
If you prefer to authorize credit card payment for the balance due, you may do so by faxing a copy of this invoice with the
appropriate credit card information and authorization to (304) 724 -3007. You may also mail this information.
Registration Number: 871
Registrant Name: Ann Gallagher
Early -Bird Special Registration at $275.
TOTAL COST $275.00
TOTAL PAID $0
BALANCE DUE $275
PO NUMBER: 21313
Thank you for your prompt attention to this matter.
Lifesavers Conference Staff
April 11 -13, 2010 o Pennsylvania Convention Center, Philadelphia, PA
March 27 -29, 2011 o Phoenix Convention Center, Phoenix, AZ
www.lifesaversconference.org
P.O. Box 30045 0 Alexandria, VA 22310 0 703.922.7944 0 703.922.7780 Fax
4t
2010 Lifesavers Conference Registration Form
NATIONAL CONFERENCE ON K[GRWAY SAFETY PRIORITIES
APRIL I 1 --•13, 2010 PENNSYLVANIA CONVENTION CENTER PHILADELPHIA. PA
Attendee Information
t
First name: Last name: &"1/9/441h-C-e. ./1 ....y.
Preferred first name for bad e: .0...-i" t 1 t
bed4 Apnt 11 13 zoo i
Organization: (_,9- /4-r v /1 Pennsy[PaniatOrtventton
s y ,srtv ar liPxsdverxconferanceorg
Address: 3 C1 C... e. rsg s 7t
City: /��n State�� Zip: Li GI, 0 2___ -w 1!
;7 M` `,.1 J
Telephone: (.S i 2 -0 Fax: 3 17 77 S 7/ .-25s/L
E -mail: 17G #9//49Aei C.-gtwe 7" 6-12v
Registration information will be sent to the email address above.
List any additional email addresses your confirmation should be sent to: Payment Terms
t: Registration must be mailed by April 1, 2010.
After that date wait and register on -site.
Special Requirements:
E Registration fees must be paid by check in
Your registration fee includes an opening reception, two continental breakfasts, three lunches, U.S. dollars (payable to Lifesavers Conference,
refreshment breaks, exhibits, workshops, and program materials Inc.), credit card (Visa or MasterCard) or
heck here if you do not want your contact information printed nference materials
.......1 attached purchase order. We do not accept
i
American Express.
Is this your first Lifesavers Conference? Yes No E Registrations received without payment or
What field oyou work in? Consultan t/ Researcher Community Programs purchase order number will not be processed.
EMS /Fire Local Government
Child Passenger Safety Public Health /Medical State /Federal Govt. f:NDT£:}3COUVAIINOY� ttE!GLSTERT Y IiON£?i
Child Restraint Manufacturer la1aw forcement Auto Industry
Consumer Group Judge/Prosecutor Send this form with your payment or purchase
Advoca
cy/ p Insurance Industry order to:
Registrat•on Fees: (Check one) By Mail: Lifesavers Conference, Inc.
Early laird Special until January 11, 2010 $275 Conference Registration
Early Registration on /before 1/12/2010 2/26/2010 $350 P.O. Box 30045
ID Late/On-Site Registration after February 26, 2010 $425 Alexandria, Virginia 22310
Moderator /Speaker $275 Or Fax:
Moderator /Speaker (one day, day of attending presentation only) No Charge (703) 922 -7780 Do not mail form after faxing
Please Indicate day Lifesavers Fed. ID 52- 1648356
Total Amount Due NOTE: If you do not receive a confirmation via
Note: Additional exhibit personnel please use the exhibit registration form. email or U.S. mail from us within 14 days, please
contact us at (703) 922 -7944 or email us at
registrar @PTFAssociates.com
Payment Method: Check one: Visa MasterCard Check Purchase Order*
Paying by credit card or purchase osier? Register online at www.lsaversconference.org
Cancellation Policy:
Card Number: Expires: CW2 Code:
The (W2 code is a? -digit rode found on the bock of your credit cardfobawing the credit cord number Registrations cancelled on or before March 29, 2010
I agree to pay the above total amount according to card issuer agreement. will receive a refund minus a $25 processing fee.
After that date there are no refunds. Cancellations
must be sent in writing to Lifesavers Conference, Inc.
Signature: or emailed to: registrar ®PTFAssociates.com
Print name as it appears on card:
Purchase order must be attached. Indicate bill to address if different from above registration address. Contact information will only be used
Attn: Organization: for meeting purposes. The registration
list is offered for sale to exhibitors only.
Address: City/State /Zip:
W W W. L i F E 5 A V E R S C 0 N F E R E N C E. 0 R 0
0 INDIANA RETAIL TAX EXEMPT PAGE
J L of C °,4 L (�l. CERTIFICATE NO. 003120155 002 0 1 of 1
l�.ci Si a PURCHASE ORDER NUMBER
i- Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 71 11 2
3.ZAK CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, NP
CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
January 5, "2010 training
7
Lifes avers Conference, Inc. SHIP City of Carmel. Police Department
Conference Registration T C 3 Civic Square
P.O. Box 20045 Carmel, IN 46032
Alexandria, VA 22310
cONFIRMATON BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY !UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
2010 Lifesavers Conference for Ann Gallagher 275.00
on ApitI 11 13, 2010 in Philadelphia, PA
0
0
St
A „9
A.,:-.,
Send Invoice To: City of Carmel Police Jae 0:., !I I
ATTN: Teresa Anderson
3 Civic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE.
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
210 5!0 cont ed fund PAYMENT
AYP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID.,
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. Y l pt I j 1 a Y
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY +�1. L;L L f%�LF d
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
213 CLERK TREASURER
DOCUMENT CONTROL NO.
A 40 COPY SIGN AND RETURN TO CLERK'S OFFICE
V DUCHER NO. WARRANT NO.__
•L' ALLOWED 20
IN THE SUMOFS
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
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-----
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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.
Payee
Lifesavers Conference Purchase Order No. 21313F
P.O. Box 30045 Terms
,''Alexandria, VA 22310
ATTN: Accounts Receivable Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/18/10 payment for 2010 Lifesavers Conference for Ann 275.00
Gallagher on April 11 13, 2010 in Philadelphia, PA
Total
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
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Lifesavers conference IN SUM OF
P.0. Box 30045
Alexandria, VA 22310
ATTN: Accounts Receivable
275.00
ON ACCOUNT OF APPROPRIATION FOR
coht-ed};fund
Board Members
NO. #!TITLE AMOUNT hereby certify invoice(s), INVOICE NO ACCT I hereb certif that the attached invoice( s or
21313F 570 275.00 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
January 27 20 10
10
Signature a
Chief of POlice
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund