HomeMy WebLinkAbout185202 05/11/2010 a CITY OF CARMEL, INDIANA VENDOR: 00351098 Page 1 of 1
ONE CIVIC SQUARE SHANE P COLLINS
i CHECK AMOUNT: $150.00
CARMEL, INDIANA 46032
CHECK NUMBER: 185202
CHECK DATE: 5/11/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 150.00 TRAINING SEMINARS
I'a. Fo OP FrliA USE O NL Y AMDM
HEGIS M,770N
9 7th Annul C+oa►hmcee Allay 2nd 4th
J $100 ISOA Member IJ $10 "Steelyard Shoot" Match
)($150 Non Member' J $25 Late Fee (MemberiNon Member)
Total: rk .00 ;J $150 Glock Course Fee J Additional Banquet Tickets $25 each
An application form must be submitted for each and every atte
M 1 L1.111 WE
S hon e .ns....
AGENCY ASSIGNMENT /RANK /TITLE
Corm¢( Paltre t Serget A
AGENCY ADDRESS CITY STATF ZIP LODE
CL'►•, C r
AUILING ADDRESS (OTHER THAN AG NCY) CITY STATE ...............zlp copE
EMAIL ADDRESS PNONE
I
SG� 9�_� 3r
I affirm that the above information is true and accurate. Further,/ authorize the Indiana SWAT Officers Association
to contact my employer and verify my employment and assignment, if necessary.
SIGNATURE DATE
IMPORTANT: Will you be attending the banquet? RYES 1J N0 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, 2410, 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: 0 VISA J
CREDIT CARD NUMBER EXPIRATION DATE 3 DIGIT AUTHORIZATION CODE
i
i
NAME 0H CREDIT CARD AUTHORIZATION 5iGNATVRE
ADDRESS CITY STATE I 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 J PART -TIME J RETIRED IJ AUXILIARY/RESERVE J ACTIVE MILITARY J RESERVE MILITARY
e o• i
1V o e
ATTENDEE CONFER
n
NAME: kfl1 AGENCY: G/n tt
Sunday, .May,,2nd
1000 to 1500 ISOA Steelyard Match YES I will be participating P<NO I will not be participating
Monday; May 3�dTueSc€�y May 4th
PRIORITIZE YOUR SELECTIONS 1 THROUGH 5 PRIORITIZE YOUR SELECTIONS 1 THROUGH 5
0800 to 1200 X0900 to "1300
Physical Conflict Resolution G Krav Maga Worldwide iecc,,. f::,,;
Tactical Respiratory Protection :rs.,t; r Active Shooter Movements
Selection and Training !'c e Iranian Embassy Seige (1980) Debrief z
Dynamic Room Clearance Tactics SMG Applications i? r; ?hl
o High Performance Pistol Advanced Assault Tactics e,a
0800 tc 1700.:' 10 to 1800,
ALS Tech. Chemical Mun. Instruct, lt:r.'t;mr; ALS Tech. Diversionary Device Instruct.
Emergency "Self -Aid" .ris ?:;r Glock Armorer's Course ($150 Fee)
'Multi- Breach Point Strategies iis;`re+ Edged Weapon Deployment ...0 ruri„ r,; r!
'Def -Tec NFDD Instructor Certification r,:; Close Protection for LE (VIP Details)
o w Def -Tec Less Lethal Instructor F!J ,r(i rtY *Chemical Munitions Instructor
Operational Overview Planning Fr:'r: The Sniper Program GA'<in
High Speed Tactical Shotgun H TFTT 2 -Man Team Tactics
TFTT 2 Man Team Tactics s ;;f: Q Rapid Deployment Pistol Operator Kr:,,e
Ballistic Shield Deployment Tactical Casualty Management v
Tactical Casualty Management r Explosive Breaching V,-1:1,V,
Explosive Breaching Officer Down Rescue C'c =;rr
Urban Rifle i, Urban Rifle 8r:rift
CTS NFDD Instructor Certification ta rr;, .1300 t017007:,
One Shot Sniper Seminar .r.nr,< Physical Conflict Resolution
Active Shooter Movements u Wf)
Krav Maga Worldwide Fr,z rr s.en
Dynamic Room Clearance Tactics :r;
L� High Performance Pistol t:• r:;,ts
This form must be submitted with your Registration Form
Please Note: Paul Howe's "Selection Training" on Monday, May 3rd and Phil Singleton's "Iranian Em-
bassy Seige (1980) Debrief" on Tuesday, May 4th have no restrictions. All other courses, unless indi-
cated with an "i` above, are restricted to two (2) persons per agency. If there are additional openings
after April 9th, we will do our best to accommodate your course preferences based on the order in which
applications have been received.
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CITY OF CARMEL Expense Report (required for all travel expenses)
EMPLOYEE NAME: Shane Collins DEPARTURE DATE: 5/2/2010 TIME: 1100 AM PM
DEPARTMENT: Police Dept. RETURN DATE: 5/4/2010 TIME: 1800 AM/PM
REASON FOR TRAVEL: SWAT conference DESTINATION CITY: Fort Wayne, IN
EXPENSES ARE FOR (check all that apply) TRAVEL ADVANCE TRAVEL REIMBURSEMEN' TRAVEL PER DIEM X
Date Transportation Gas/Tolls/ Lodging Meals Misc. Total
Air -fare Car Rental Other Parking Breakfast Lunch Dinner Snacks Per Diem
5/2/10 $50.00 $50.00
5/4/10 $50.00 $50.00
5/4/10 $50.00 $50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
0.00
Totall $0.00 $0.00 $0.00 $o.00 $0.00 $0.00 $0.00J $0.001 $0.00 $150.001 $0.00
DIRECTOR'S STATEMENT: I hereby affirm that all expenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date: -/0 t o
City of Carmel Form ER06 Revision Date 5/7/2010 Page 1
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
Shane P. Collins Purchase Order No.
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
the SWAT conference on May 2
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
S hane P. Collins IN SUM OF
150.00
ON ACCOUNT OF APPROPRIATION FOR
cont ed fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
210 570 150.00 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
May 10 20 10
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund