182924 03/03/2010 CITY OF CARMEL, INDIANA VENDOR: 362658 Page 1 of 1
ONE CIVIC SQUARE MARRIOTT PHILADELPHIA DOWNTOWN
iro CARMEL, INDIANA 46032 1201 MARKET STREET CHECK AMOUNT: $528.75
PHILADELPHIA IL 19107
CHECK NUMBER: 182924
CHECK DATE: 313/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 R4343002 21303 528.75 LODGING
INVOICE
Date: March 1, 2010
Sold to: City of Carmel Police Department
3 Civic Square
Carmel, IN 46032
Payment for lodging for Ann Gallagher on April 10 13, 2010 in Philadelphia, PA
Confirmation #3243FPC40
Room Rate Tax Total
$153.00 $23.25 $176.25 x 3 $528.75
TOTAL DUE: $528.75
Please make check payable to:
Philadelphia Marriott Downtown
1201 Market Street
Philadelphia, PA 19107
2010 Lifesavers Conference Registration Form
N A T I O w F 1 1 1 L C 0 N F E T R E N i C E 0 G H W AY S A FE T Y P R f 0 R I T I E S
APRIL I 1 13, 2010 PENNSYLVANIA CONVENTION CENTER PHILADELPHIA, PA
Attendee Information: -my,
First name: Last name: i
Preferred first name for bad e: ft
Organization: De
Address: Y _Z,
City: Stat;Zkz Zip: LAP 03 2—
Telephone: Fax:
E -mail: e, Cr4-,*7 e
Registration information will be sent to the email address above,
List any additional email addresses your confirmation should be sent to: P ayment Term s
t Registration must be mailed by April 1, 2010.
1 After that date wait and register on-site.
Special Requirements: I L Registration fees must be paid by check in
Your registration fee includes an opening reception, two continental breakfasts, three lunches, i U.S. dollars (payable to Lifesavers Conference,
refreshment breaks, exhibits, workshops, and program materials
I Inc.), credit card (Visa or MasterCard) or
nf attached purchase order. We do not accept
Check here if you do not want your contact information printed p� n materials i
F American Express.
Is this your first Lifesovers Conference? Yes B"K�o Registrations received without payment or
t
purchase order number will not be processed.
Wha "eld oyouworkin? E_J Consuttant/Researcher 0 Programs
f
E) EMS/Fire El Local Government
;Chi! Passenger Safety Public Health/Medical State/Federal Govt.
Child Restraint Manufacturer 11_La*f�iforcement Auto Industry Send this form with your payment or purchase
Advocacy/ConsumerGtoup Judge/Prosecutor Insurance Industry order to:
t
Regis ation Fees: (Checkone) By Mail:
Lifesers Conference, Inc.
4 Lifesavers
Special until January 11, 2010 $275 Conference Registration
Early Registration on/before 1/12/2010 2/26/2010 $350 P.O. Box 30045
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 I Lifesavers Fed. ID P 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. maiLfrorn us within 14 days, please
contact us at (703) 922-7944 or email us at
Payment Method: Check one: ❑Visa 0 MasterCard Check E��P.,che Order* com
Paying by credit card or purchase order? Registeronline at wmv.lifesaversconference.org
Caricettation Policy:
Card Number: Expires: CW2 Code: Registrations cancelled on or before March 29, 2010
Fh,CWWeh. hoda 1y.—da—dPii-9 will receive a refund minus a $25 processing fee.
logree toppythe above total amount according to cord issuer agreement. After that date there are no refunds; Cancellations
must be sent in writing to Lifesavers Conference, Inc.
Signature: or emailed to: registrar@PTFAssociates.co
Print name as itappears on card:
Purchase order must be attached. Indicate bill -to address if differentfrom above registration address. Contact information will only be used
Organization: for meeting purposes. The registration
Attn:
List is offered for sate to exhibitors only.
Address: City/State/Zip:
INDIANA RETAIL TAX EXEMPT PAGE City f Carmel'
CERTIFICATE NO. 003120155 002 0 1 1
PURCHASE ORDDEE R NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 21303
26 E ,CIVIC SQUARE FTHIS MBER MUST APP EAR ON INVOICES, A/P
CARMEL, INDIANA 46032 -2584 R, DELIVERY MEMO, PACKING SLIPS,
G LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION VENDOR NO. DESCRIPTION
NO.
December 17, 2109 lodging :L
VENDOR Philadelphia Marriott Downtown SHIP City of Camm Police Department
1201 Market Street TO 3 Civic Square
Philadelphia, PA 19107 Carmel, IN 46032
CONFIRMATION BLANKET I CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
payment for lodging for Ann Gallagher while 528.75
attending the L-iddeavers Conference on April
11 13, 2010 in Philadelphia, PA
Send Invoice To:
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 430 -02 training, travel lodging
PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
I VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID..
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
R t CLERK TREASURER
DOCUMENT CONTROL NO.
F AQ COPY SIGN AND RETURN TO CLERK'S OFFICE
V4VUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
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
i
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
Philadelphia Marriott Downtown Purchase Order No. 21303RF
1201 Market Street Terms
Philadelphia, PA 19107 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
p ayment for lodging for Ann Gallagher while attending 528-75
e 20 10 Lifesavers e en e on AprJ1 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
VOU,: HER NO. WARRANT NO.
ALLOWED 20
Philadelphia Marriott Downtown IN SUM OF
1201 Market Street
Philadelphia, PA 19107
528.75
ON ACCOUNT OF APPROPRIATION FOR
p olice general fund
Board Members
DEPT. or INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
21303RF 430 -02 528.75 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 24 2 0 10
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund