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Home My WebLink About186775 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 364285 Page 1 of 1 L ONE CIVIC SQUARE COMM ON FIRE PREVENTION AND CONTRA CARMEL, INDIANA 46032 34 PERIMETER ROAD CHECK AMOUNT: $1,400.00 WINDSOR LOCKS CT 06096 CHECK NUMBER: 186775 CHECK DATE: 6/23/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4357004 1,400.00 EXTERNAL INSTRUCT FEE Student Application A separate application is required for each course. Your ID Consist oWhe -First (3) Letters of your last name Please print/type and mail /fax with payment to: and Last (4) number of your social security number CFPC, 34 Perimeter Road, Windsor Locks, Cr 06096 -1069 ID Number .1 Example: John Adams SS 000-00-5555 Fax (860) 6541889 The new ID It will be ADA -5555 Last Name /J/ C LE As Chief of the First Name WEE Fire Department or as Supervisor of the organization, Home Address y5 N q W a vs I hereby authorize the above applicant to partici pate in the program beEow arid, therefore, understand that the above -named individual will be covered by my organization's worker's .ompa ^cation Insurance while participating in such training, and that the Commission on Fire Prevention and Conuol, its commissioners, officers, agerts or employees shall rot be liable for any injuries sustained during such training. finis applicant is mnsideied by my deparmen s standards w be physically and emotionally fit to perform tirefiahtin e`r,lunars without spedal considerations, and where aglhcable, tr meet the 29 Cr,R 1914. City �/}If0 r✓ s :andatd for the use of respirators (Self Centaired Breathi g Apparms). Chief or Supervisor Signature State rJ Zip O S,Z No application hill be accepted without tuition, authorized signature and proof of prerequisite (if needed). Proof included. Register me for the following course: Phone (Home) Course Title Work Course o Cell 't u t -7 Date(s) Tuition Method of Payment Payment is required at time of registra- Pager tion. Faxes must include Credit Card or Purchase Order Fire Department/Oiganization CA4Lr4E L Ft 9X be PT 1 -.I Check made payable to CFPC Purchase Order Entail ��rt x9_ G v%Ov, coM L3VISA MasterCard Card Check box if you would like to subscribe your e -mail address to the CFPC listserve. Card Holder's Name: Are you 18 years of age or older? es ^I No (No one under 18 is allowed to participate in hands -on programs) Card Holder's Signature: Exp. Date: Student Application A separate application is required for each course. Your ID Consist of the First (3) Letters of your bast name Please printhype and mailffax with payment to: and Last (4) number of yoursocial security number CFPC, 34 Perimeter Road Windsor Locks Cr 06096-1069 ID Number Example: John Adams SS a 000 -00 -5555 Fax (860) 654-1889 The new ID will be ADA -5555 Last Name CC P_ 11' As Chief of the First Name r 5A Fire Department or as Supervisor of the V 2 EDEN w� organization. Home Address Q t I l ereby authorize tr:e above applicant to participate in the program below and, therefore, understand that the above -named individual will he cevered by my organizat'ion's worker's coinGensation Insurance while participating in such trairing, and [hat the Commission on Fire Prevention anc: Control, ius commisslaners, cfficers, agents or employees shall not be liable ii any in}uries sustained during such training. This applicant is considered by my dcpaiimen-; s standards to be physically and emotionally fit to pernorm city CQ,QPAC L f' reigittiroeveiutionswithowspecial considerations, andwheie applicable, tomeel the 29Lrrt1910,134 standard (or the use of respirators (Seli- Coniained Breathing Apparatus). Chief or Supervisor Signature L State Zip application w l be accepted without tuition, aumoozed signature and proof of prerequisite (if reeved). T �J QQ ^_i Proof included. Register me for the following course: Phone (Home) 31'7 S d 2 SU 1/ I Course Title work r(3 S I 4. (o b� Course Q G Cell 7) �d Z Date(s) Tuition Method of Payment Payment is required at time of registra- Pager tion. Faxes must include Credit Card or Purchase Order Fire Department/Organization Q lAi F; IRE QE P l Ch eck made payable to CFPC J Purchase Order Email ;_-,VISA MasterCard Card Check box if you would like to subscribe your e -mail address to the CFPC listserve. Card Holder's Name: Are you 18 years of age or older Yes No (No one under 18 is allowed to participate in hands -on programs) Card Holder's Signature: Exp. Date: Akh JA Paw ft No w k sheop The purpose of the IAFF -IAFC -ACE PFT certification program is to provide a fitness trainer standard consistent with the health and fitness needs of the Fire Service throughout the United States and Canada. The Peer Fitness Trainer (PFT) program was created so interested fire department personnel could obtain certification in fitness- program design and implementation in order to help their peers with their fitness programs on a one -on -one basis and to help with the physical; training of recruits. Those successfully passing the certification exam will have demonstrated they pos- sess the knowledge and skills required to design and implement fitness programs, improve the wellness and fitness of the uniformed members in their de- partments, assist in the physical training of recruits, and assist the broader community in achieving well- ness. and fitness. The class consists of a five -day PFT workshop to d� assist the candidate in successfully achieving certi- fication. The class must consist of a minimum of r 25 students or cancellation of the class is manda- tory. The American Council on Exercise (ACE) is the certifying organization that awards the`�� IAFF /IAFC /ACE Peer Fitness Trainer Certification to candidates successfully passing the certification exam. Chess hours: 40 Eligibility Requirements: In order to be eligible to take the PFT examination you must be a y firefighter, EMS provider, or employed by a fire department and involved in a fitness pro- gram. Examination candidates must possess a valid CPR certification by the day of the ex- amination. For additional information look on the IAFF website www.lAFF.org under Programs Services> Health and Safety >Wellness and Fitness> Peer Fitness. Class Materials: Workout Clothing, Bring All Study Materials. Fee: $700.00 Per Person Includes Books, Class and Certification Test Monday— Friday 0800 -1700 hrs For General and Lodging Information Location: New Britain Fire Department Contact: Bill DeFord Host at Central Connecticut State Univ. Cell: 860 -916 -0588 1615 Stanley Street Office: 860 -627 -6363 ext. 343 T New Britain, CT 06051 t (Location on campus TBD) tf k a� t gin. r Contact Inforniation and Amf cation on Back ,a VOUCHER NO. WARRANT NO, CFPC ALLOWED 20 t try i� h /lcf/�� IN SUM OF 34 Perimeter Road Windsor Locks, CT 06096 $1,400.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department QO# Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members 1120 43- 570.04 $1,400.00 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 JUN 21 210 r� f Fire Chief 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Regis. Fee Griffin Nicley $1,400.00 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