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Home My WebLink About182871 03/03/2010 CITY OF CARMEL, INDIANA VENDOR: 361689 Page 1 of 1 ONE CIVIC SQUARE HOLIDAY INN EXPRESS CHECK AMOUNT: $157.32 CARMEL, INDIANA 46032 5915 ELLISON ROAD FT WAYNE IN 46804 CHECK NUMBER: 182871 CHECK DATE: 3/312010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 157.32 TRAINING SEMINARS r INVOICE Date: February 24, 2010 Sold to: City of Carmel Police Department 3 Civic Square Carmel, IN 46032 Payment for lodging for Ryan Jellison and Shane Collins on May 2 4, 2010 in Ft. Wayne, IN Confirmation #60153811 Room Rate Tax Total $69.00 $9.66 $78.66 x 2 $157.32 TOTAL DUE: $157.32 Please make check payable to: Holiday Inn Express 5915 Ellison Road Ft. Wayne, IN 46804 F oR ^FFiCiAL USE Ohl F' A E a RE(NsTmnom 7th Annual Ccn9emee May 2nd 4th a� d $100 ISOA Member $10 "Steelyard Shoot" Match $150 Non-Member' $25 Late Fee (Member/Non- Member) To .00 $150 Glock Course Fee Additional Banquet Tickets $25 each An application form m ust be sub mit te d f each and every attendee FIRST NAME M.1. LAST NAME AGENCY ASSIGNMENT /RANK /TITLE �a.r..t� e 1.. 0..\•`�.�._ AGENCY ADDRESS CITY 1 i .AT 'ZIP CODE 1 1 1 CITY MAILING ADDRESS THAN AGENCY STATE i ZIP CODE 5 5...... o r-c- S_} r l� 0(_ E-MAIL ADDRESS kk :PHONE Q ca, <j .J �.Ay �.l -7 „72 I affirm that the above information is true and accurate. Further t authorize the Indiana SWAT Officers Association to contact my employer and verify my employment and assignment, if necessary. SIGNATURE I DATE IMPORTANT: Will you be attending the banquet? jZYES LINO Number of additional tickets requested Federal Tax ID Number: 57 1177923 You are considered pre registered if your registration form” and payment (agency purchase order, check, credit card', DOJ voucher, or money order) are received prior to April 9, 2010. Any registration form received after April 9, 2010, will result in a $25.OD late fee. NOTE: We WILL NOT accept registrations on the day of the Conference. Additional banquet tickets can be purchased for $25.00 per ticket (limited quantity available). 'Registration fee includes: Attendance at Conference, vendor appreciation day, lunch and banquet dinner on Monday, May 3rd, and lunch on Tuesday, May 4th. 'There will be a $3.00 additional processing fee for credit card payments If you are pre registered and cancel prior to April 9, 2090, your registration fee will be refunded less a $50.00 administrative charge. No refunds will be issued after April 9, 1010. However, suitable substitutions will be allowed. If paying by credit C card, please complete the following: d VISA CREDIT CARD NUMBER I........ EXPIRATION DATE 3 DIG .....IT A H .ORIZAT... O \I I IT AUTHORIZATION Rk! ODE NAME ON CREDIT CARD AUTHORIZATION 3FGNATOR[ ADDRESS CITY STATE ZIP CODE IMPORTANT: Your credit card will be charged the day your registration form and payment are received by the ISOA. Please include the billing address where the monthly statement is seat. PLEASE CHECK: FULL -TIME J PART -TIME ..I RETIRED 'J AUXILIARYIRESERVE J ACTIVE MILITARY IJ RESERVE MILITARY o a I Fo,f 0FF!0AL USE ONLY A7mz Tio mll i] 7th Annual Conhmnoe May 2nd 4M1 $100 ISOA Member iJ $10 "Steelyard Shoot" Match X $150 Noll- Member' J $25 Late Fee (MemberlNon Member) T0ta1: J $150 Glock Course Fee J Additional Banquet Tickets $25 each An application form must be submitted for each and every attendee �E FIRST NAME ��4I12 M1. LAST NAME IIrrS AGENCY ASSIGNMENT I RR ANK K/ /TIIT AGENCY APDRf _pl of ,CITY... Gi 1 ML�II �STATF ZIP CODE MAILING ADDRESS (OTHER THAN AG NCY) CITY STATE ZIP CODE am p. C�,nG ��n�l T 46033 F -MAIL ADDRESS PHONE SC�IfkhSLC4rrrte,(..��•..��V. I affirm that the above information is true and accurate. Further, 1 authorize the Indiana SWAT Officers Association to contact my employer and verify my employment and assignment, if necessary. SIGNATURE OATf. r�a IMPORTANT. Will you be attending the banquet? RYES J NO Number of additional tickets requested: Federal Tax ID Number: 57- 1177923 You are considered pre registered if your registration form* and payment (agency purchase order, check, credit card DOJ voucher, or money order) are received prior to April 9, 2010. Any registration form received after April 9, 2010, will result in a $25.00 late fee. NOTE: We WILL NOT accept registrations on the day of the Conference. Additional banquet tickets can be purchased for $25.00 per ticket (limited quantity available). *Registration fee includes: Attendance at 'Conference, vendor appreciation day, lunch and banquet dinner on Monday, May 3rd, and lunch on Tuesday, May 4th. *There will be a $3.00 additional processing fee for credit card payments If you are pre registered and cancel prior to April 9, 2010, your registration fee will be refunded less a $50.00 administrative charge. No refunds will be issued after April 9, 2010. However, suitable substitutions will be allowed. If paying by credit card, please complete the following:; �I CREDR CARD NU,MBE0. EXPIRATION DATE 3 DIGIT AUTHORIZATION CODE i F NAME ON CREDIT CARD AUTHORIZATION SIGNATURE ADDRESS CITY STATE ZIP CODE IMPORTANT: Your credit card will be charged the day your registration form and payment are received by the ISOA. Please include the billing address where the monthly statement is sent. PLEASE CHECK: FULL -TIME PART -TIME J RETIRED 'J AUXILIARY /RESERVE J ACTIVE MILITARY J RESERVE MILITARY e a rt e o e• 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 Holiday Inn Express Purchase Order No. 5915 Ellison road Terms Ft. Wayne, IN 46804 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 2/24 payment for 16dging for Sgt. Ran Jellison and Sgt. 157.32 Shane Collins while attending the ISOA Conference on May 2 4 2010 in Ft. Wayne, IN 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 Holiday Inn.Express IN SUM OF 5915 Ellison Road Ft. Wayne, IN 46804 157.32 ON ACCOUNT OF APPROPRIATION FOR NN5rXX.XXgXNX.XXXXXRNAX cont ed fund Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 210 570 157.32 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 February 25 20 10 Signature Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund