191532 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 363971 Page 1 of 1
ONE CIVIC SQUARE A P C O
CARMEL, INDIANA 46032 351 N WILLIAMSON BLVD
CHECK AMOUNT: $598.00
DAYTONA BEACH FL 32114
CHECK NUMBER: 191532
CHECK DATE: 11/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4355300 598.00 ORGANIZATION MEMBER
PUB C
I APCO Inteati®nal ANNUAL DUES INVOICE
p federal ID Number 63 -046 -1885
C p Association of Public- Safety Communication Officials
APCO INTERNA'rIONAL INC.
351 NORTH WILLAMSON BLVD.
DAYTONA BEACH, FLORIDA 32114
888- AI'CO9 -I -I OR 386 -322 -2500
Janet Arnone
Office Administrator Statement Date: 10/29/2010
Carmel Clay Communications Center P.O. Number:
31 1 St Ave NW
Carmel, IN 46032 -1715 Bill Code: 308659
Total Amount Due: $598.00
You are being billed for: 2011 APCO Membership Dues
Note: Return statement with remittance.
Please indicate those individuals no longer with your organization by drawing a line through their name.
Each new member requires a new application. Please complete the application on the back. Duplicate application as needed.
MBR CAT. NAME DESCRIPTION AMOUNT DUE
Primary Chapter Original Amt Amount Due Amound'aid Balance
96109 AC Bill Akers Q IN S92.00 $92.00 S0.00 $92.00
358155 MB Mindy Collins IN S69.00 $69.00 50.00 $69.00
311235 MB Peggy Gordon IN S69.00 S69.00 $0.00 $69.00
359390 AC John Jokantas IN $92.00 592.00 S0.00 $92.00
96115 AC Todd Luckoski IN $92.00 S92.00 50.00 $92.00
86057 AC Marvin Stewart IN $92.00 S92.00 50.00 $92.00
229379 1 AC Dennis Stilts IN I S92.00 S92.00 S0.00 S92.00
Total Amount Due: $598.00
Page 1 of 1
Iii.1 linlerniaTROMU APPLICATION FOR MEMBERSHIP
Association ofPublic- Safety Connareuiratious Officials- 177ternational, Inc.
ll fl p
Name Title
Organization Amateur Call Sign
Organization Address City State Lip
Email Phone Fax
Home Address City State Zip
Primary Address: Home Work Referred by- Future Invoices: Bill me directly Bill Agency Group
o •a
Active: Tier One $92.00 USD Agency Category Please select the one that best firs.
Individuals who are employed by, retired from, or volunteer for a governmental entity Consolidated Dispatch Center Fire Department
or a contractor for a governmenral entity and are responsible for the management, ❑Emergency Management Z) Law Enforcement
design, construction, installation, command, and operation of public safety EMS PSAP
communications systems and supporting information systems. Active members may Government Agency Other
vote on association matters, enjoy all benefits and, except where otherwise limited,
serve in any capacity in the association and its chartered groups.
Job Classification Please select the one that hest fits.
Active: Tier Two $120.00 USD 9 -1 -1 Coordinator Sheriff
Applicants as defined above in Tier One residing in California, Louisiana and Oregon Director Supervisor
are to select this Tier. Engineer /Technician Telecommunicator /Dispatcher
(NTore: Tier selectionlmembership dues are set by each respective Chapter). Fire Chief Training and Education Coordinator
Information Systems County /State Official
Member $69.00 USD ❑Manager C1 Other
Individuals who are nor eligible for either of the Active categories. Eligible individuals Police Chief
not working in administrative or supervisory roles may also choose this category if
they are not interested in voting privileges.
17 0 0
Commercial members use application at: Check enclosed ❑AMEX Mastercard Discover Visa
hrtp: /ww�v.apcoinrl.org /new /membership /app_comm.php
Card Number
Additional Chapters:
Persons residing and/or permanently employed in the chartered area of a chapter Expiration Date Security Code
are required to be members of such charrered Chapter. Members belonging to one
Chapter may become a member of any other number of Chapters as outlined in the Signature
Bylaws. Please list the additional Chapters by name:
Print Name
Mail completed application with payment to: APCO International Membership
of Addirional Tier 1 Chapters: X $18.40 351 North Williamson Blvd, Daytona Beach, FL 32114
Or Fax to 386322.2501
of Additional Tier 2 Chapters:— X $46.20 Your membership will become activated upon full paymenr of applicable dues.
Total Due
Note: $35 of your membership goes to your subscription to Public Safety Comrtttcnications l APCO Bulletin ]ournal. APCO International annual dues are not a deductible
contribution for federal tax purposes, but may be deducted as a business expense. Public Safely Communications subscription price far one year ($35) is included in membership
dues and members may not deduct the subscription price from dues. APCO estimates that an additional 7.6% of your dues are not deductible because of APCO's lobbying activities
on behalf of its members. Rates valid through September 30, 2011. Membership runs through the calendar year. See website for prora -ion information.
t
MIIYIAP910
V NO. WARRAN N O.
ALLOWED 20
APCO International
A. IN SUM OF
351 N. Williamson Blvd.
Daytona Beach, FL 32114
$598.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO41 Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1115 I I 43- 553.00 I $598.00 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
Wednesday, November 03, 2010
Director
Tille
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))
10/29/10 I I I $598.00
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