184435 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 359860 Page 1 of 1
ONE CIVIC SQUARE PELHAM SPECIALITY TRAINING INC
t 699 E DILLMAN ROAD CHECK AMOUNT: $350.00
CARMEL, INDIANA 46032
BLOOMINGTON IN 47401 CHECK NUMBER: 184435
OM
CHECK DATE: 4/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4357004 350.00 EXTERNAL INSTRUCT FEE
Course Information: Please indicate which course(s) you would like to take and be sure to indicate your preferred
course start date(s) in the Start Date column.
Course: Start Date X Recertification X Certification
CPR (AHA BLS Healthcare Provider Course $35.00 45.00
EMT Courses:
First Responder n/a n/a $250.00
EMT Basic Standard 3 Months 1 Twice Weekl n/a n/a $700.00
EMT Basic Accelerated 14 Days Dail n/a n/a $1,500.00
EMT Basic Tactical Medical Care Course n/a n/a $3,500.00
Paramedic n/a n/a $5,500.00
Paramedic Accelerated Please download an application packet from our web site.
EMS Continuing Education Courses:
EMT Basic Refresher n/a n/a $150.00
Paramedic Refresher n/a n/a $350.00
Practical Exams and Prep Courses:
BLS Practical Skills Exam EMT-B) n/a n/a $100.00
National Registry Written Preparation Course n/a n/a $300.00
Wilderness Courses:
Wilderness First Aid SOLO n/a n/a $200.00
Wilderness Medical Upgrade n/a n/a $375.00
Specialty Courses:
Primary Instructor Course n/a n/a $500.00
PHTLS (Pre-Hospital Trauma Life Support) $75.00 $150.00
PALS Pediatric Advanced Life Support) $75.00 $150.00
PEPP Pediatric Edu. For Prehos ital Professionals $75.00 $100.00
AMLS Advanced Medical Life Support) $75.00 $150.00
ACLS Advanced Cardiac Life Support) $75.00 $150.00
Administration Fees:
California and Alaska Residents please add $100.00
Students coming from outside the 50 US states US citizens included lease add $150.00
Re -Certs Initial Certs
Course Subtotals: S
Course Total (Re -Cert Subtotal+ Initial Cert Subtotal)
I agree to comply with the policies and procedures of Pelham Training. I understand that if t knowingly provide
false information, my enrollment may be revoked, and may be cause for dismissal from the program.
Signature: Date:
Page 2 of 3
i t
VOUCHER NQ. WARR NO.
,Pelham Specialty Training, Inc. ALLOWED 20
IN SUM OF
699 E. Dillman Road
r
Bloomington, IN 47401
$350.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1115 43- 570.04 $350.00 1 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
Friday, April 02, 2010
Directo
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
t
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/01/10 I I I $350.00
i
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