189496 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 355386 Page 1 of 1
ONE CIVIC SQUARE ROSEN PLAZA HOTEL CHECK AMOUNT: $766.97
CARMEL, INDIANA 46032 9700 INTERNATIONAL DRIVE
ORLANDO FL 32819 CHECK NUMBER: 189496
CHECK DATE: 8/3112010
DEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER AMOUNT DESCRIPTION
1120 4343002 766.97 EXTERNAL TRAINING TRA
RDSEN Reservation Phone Dumber: 1- 800 627 -8258
P Res e rvat i o n
J.�. Z 9700InternaonalDive, Ora -8122
H http: /www.RosenPlaza.com
PLEASE VERIFY ALL INFORMATION FOR ACCURACY
Guest Information: Room Total Date Stay Rate Rate
GARY BRANDT $675.00 Surcharge Sunday, September 26, 2010 $135.00
CARMEL, IN 46032 USA Taxes
Monday, September 27, 2010 $135.00
Tuesday, September 28, 2010 $135.00
Wednesday, September 29, 2010 $135.00
Thursday, September 30, 2010 $135.00
Home Phone: 3178482487
Email Address: gbrandt @carmel.in.gov ACCOMMODATIONS REQUESTED
Printed On: Thursday, Aug 26, 2010 Deluxe Double
ARRIVAL DATE DEPART DATE GUEST CONFIRMATION.# ASSOCIATED WITH
09/26/2010 10/0112010 2 RR5C184A FDSOA 2010 Annual Meeting
Stay Summary: of Rms 1 All rates are exclusive of 12.5% tax and 1 OCCCD Surcharge
GTD: YES MAST
Information that you will need to know
King Beds, Connecting rooms, specific locations, and otherspecial requests noted on your reservation are not guaranteed. Rest assured
every effort will be made to meet your needs. Rosen Plaza is a smoke -free facility including all guest rooms, restaurants, lounges,
meeting rooms and public spaces. Designated smoking areas are available outside of the Hotel. The Hotel will apply a $350 cleaning
fee for guests who disregard this policy.
All approved major credit debit cards will be accepted. Please note an authorization of one night's room and tax will be taken on your
card five days prior to your arrival date. Debit Cards will show a debit in your account at this time. Any reservation with a declining credit
or debit card will be subject to cancellation. In the event that you do not arrive on your requested arrival date listed above, the card given
at the time of booking will be charged one night's room and tax
The Hotel has an agreement with the Orange County Convention Center (OCCC) and other properties in the Orange County Convention
Center District OCCCD) to pay one percent of the room rate as a surcharge (not subject to tax exemption). The OCCCD 1% surcharge
sha# be used to promote the Orange County Convention Center and tourist services in the vicinity of the Orange County Convention
5 Day Cancellation Policy
This reservation must be cancelled at least 5 days prior to arrival in order to avoid a cancellation charge.
Dine Where Celebrities Han�
I
So off Second En tree
PP k LA with the purchase of one adult entree of I
equal or greater value
Enjoy great steaks fresh seafood surrounded by the
world's largest collection of autographed celebrity caricatures
Open Nightly at 5:30 p.m. Reservations 407 996 -1787
Not Valid with any other offers
The Brad Brewer Academy is Here for Your Game! 407- 996 -3306 www.bradbrewer.com info @bradbrewer.com
Please be aware that there are two Rosen Hotels adjacent to the Orange County Convention Center.
The Rosen PLAZA is at 9700 International Drive and the Rosen CENTRE is at 9840 international Drive. Your reservation is at the ROSEN PLAZA.
I L �,L armei CERTIFICATE NO. 003120155 002 Q I I I
PORDER N UMBER
FEDERAL EXCISE TAX EXEMPT
35- 60000972 41 11
ONE CIVIC SQUARE CARMEL, INDIANA 46032 -2584 UMBER MUST APPEAA ON INVOICES,
VOUCHER, DELIVERY MEMO.. PACKING SLI
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CI OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDEN
RCHASE ORDER DATE DATE REQUIRED REQUISITION NO, VEND NO.
DESCRIPTION
812712010
FDSOA Carmel Fire Department
'ENDOR SHIP 2 Civic Square
TO
P_0. Box 149 Carmel, IN 46132
Ashland, MA 01721 (317) 571 -2622
VRRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESC RIPTION UNIT PRICE EXTENSION
Account 43-67+0 -04
2 Each Register Conference-- $805.00 $1,210.00
Sub Total: $1,210.00
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�g~ �qq fi r`.. F� E�'Y �.r 17 Fj k
end Invoice To: r I
Carmel Fire Department
2 Civic Square
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Carmel Fire Department PAYME j 1 10.00
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS TNEA.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE_ IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENTTO PAY FOR THE ABOVE ORDE
SHIP REPAID.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED, ODERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL R
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99. ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 4 111 CLERK TREASURER
IOCUMENT CONTROL NO. VENDOR COFV
Registration Fora (Register online at www.fdsoa.org)
FDSOA Annual Safety Forum Pre Registration Required
NOTE: Use one registration form per person photocopies accepted. Please return completed
form, with payment in U.S. funds, to FDSOA, P.O. Box 149, Ashland, MA 01721--0149. Make
checks payable to FDSOA. Save time register online at: http: /www.fdsoa.org.
Name: r y Y n Nickname:
Title: G i
Agen ��r� �r "c �r' -,n 7'
Address:
City: State: Zip: `/v_d S
Day Time Phone: _3 7 7 2-6 067 FAX: 7 7
Cell Phone: 5 z11 Y 7 �6 Email: �jr,,g z T
Conference Registration Fees
Member Non Member Amount
Safety Forum Only $325.00 $425.00
'Safety Forum ISO Academy $425.00 $525.00
Safety Forum HSO Academy $425.00 $525.00
ISO Academy Only $200.00 $300.00
❑HSO Academy Only $200.00 $300.00
ISO Certification Exam 95.00 $195.00.
❑HSO Certification Exam 95.00 $195.00
FDSOA Individual Membership Dues (.loin now to take advantage of the mernber rate) 85.00
TOTAL AMOUNT DUE $_nom c c�
Payment Information: (U.S. Funds, drawn on U.S. Bank)
Enclosed is a check payable to FDSOA gEnclosed is an official Purchase Order
MasterCard Visa
Card Number: Expiration Date:
Card Holder Signature: Date:
Card Holder Name: (Please Print)
Cancellations: Cancellations must be made in writing and sent to FDSOA, P. O. Box 149, Ashland, MA
01721 -0149. If received 30 days prior, 75% of Forum Registration only will be refunded; 7--29 days prior,
50% of Forum Registration only will be refunded. Less than 7 days, no refund is possible.
FDSOA Non -Profit Org.
P. O. Box 149 U.S. POSTAGE
Ashland, MA 01721 -0149 PAID
Permit No. 125
Ashland, MA
Registra Form (Register online o www.fdsoa.org)
FDSOA Annual Safety 'Forum Pre Registration Required
NOTE: Use one registration form per person photocopies accepted. Please return completed
form, with payment in U.S. funds, to FDSOA, P.O. Box 149, Ashland, MA 01721-0149. Make
checks payable to FDSOA. Save time register online at: http: /www.fdsoa.org.
Name: ti-� Nickname:
Title:
a�
Agency: C-
Address:
City: State: Zip:
Day Time Phone: "��c� FAX:
Cell Phone: Email:
Conference Registration Fees
Member Non Member Amount
Safety Forum Only $325.00 $425.00
X Safety Forum ISO Academy $425.00 $525.00 �a
❑Safety Forurn HSO Academy $425.00 $525.00
ISO Academy Only $200.00 $300.00
HSO Academy Only $200.00 $300.00
RISO Certification Exam 95.00 $195.00 °�S
HSO Certification Exam 95.00 $195.00
9FDSOA Individual Membership Dues (Join now to take advantrige of the member Tale) 85.00
TOTAL AMOUNT DUE
Payment Information: (U.S. Funds, drawn on U.S. Bank)
❑Enclosed is a check payable to FDSOA ❑Enclosed is an official Purchase Order
MasterCard Visa
Card Number: Expiration Date:
Card Holder Signature: Date:
Card Holder Name: {Please Print)
Cancellations: Cancellations must be made in writing and sent to FDSOA, P. O. Box 149, Ashland, MA
01721 -0149. If received 30 days prior, 75% of Forum Registration only will be refunded: 7--29 days prior,
50% of Forum Registration only will be refunded. Less than 7 days, no refund is possible.
FDSOA Non -Profit Org.
P. O. Box 149 U.S. POS`fAGE
Ashland, MA 01721 -0149 PAID
Permit No. 125
Ashland, MA
ti�4E DEPART,y� l
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D EC E R 5 A5
FDSOA Headquarters, P. O, Box 149, Ashland, MA 01721
Voice: 508--881- -3114 508 -881 -1128 Email: membership @fdsoa.org
Incident Safety Officer Certification Application
Applicant shall meet requirements of NFPA 1521, 2008 Edition, Chapter 4, Section 4.5.1
Please type or print all information
Name: �r� SS# Last 4 digits:
Agency: Ica r� r c: Rank: Z
Department Type: Career Combination Volunteer Other
Address: L" V r r-
City: -7e- State: Zip: 3
Day Time Phone: 7 FAX:
Cell Phone: 3�" y c 6 Email:
Professional Experience (Required)
Agency Dates Position
Z rv'a 7_e,5- N 000 T0 rc_ a z .^?,q 7� L)
To Employer (Required)
Please verify the above information by signing below:
1 verify that has been involved in the emergency
services for a minimum of five years and meets the requirements of NFPA 1521, 2008 edition,
Chapter 4, Section 4.5.1
Print Name:
Required: Chief r Chief Officer
Signature:
Required: hief or hief Officer
Rev. 01108
WAR
SAFrry
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q, �F.AL
A 55 `\er
FDSOA Headquarters, P.O. Box 149, Ashland, MA 01721
Voice: 508- 881 -3114 508-881 -11.28 Email: membership @fdsoa.org
Incident Safety Officer Certification Application
Applicant shall meet requirements of NFPA 1521, 2008 Edition, Chapter 4, Section 4.5.1
Please type or print all information
Name: SS# Last 4 digits: SDI/
Agency: Dank:
Department Type. Career Combination Volunteer Other
Address: 7
City: Cr State: Zip: l zG c 7z
Day Time Phone: 26 71 FAX: 3/ 7- .5 1-
Cell Phone: 317 533 f 705 Email: Si��'���5 �Cc� US
Professional Experience (Required)
Agency Dates Position
To Employer (Required)
Please verify the above information by signing below:�����-
i verify that has been involved in the emergency
services for a minimum of five (5) years and meets the requirements of NFPA 1521, 2008 edition,
Chapter 4, Section 4.5.1
Print Name:
Required: Chi o Chief Off' r r
Signature: f)
Require Chief or Chief Officer
Rev. 01108
VOUCHER NO. WARRANT NO.
ALLOWED 20
Rosen' Plaza Hotel
IN SUM OF
9700 International Drive
Orlando, FL 32818
'7 7
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT
Board Members
1120 43- 430.02 $767.00 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
A 3
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))
Lodging FDSOA $767.00
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