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192122 11/23/2010 CITY OF CARMEL, INDIANA VENDOR: 00351464 Page 1 of 1 ONE CIVIC SQUARE INDIANA RURAL WATER ASSOC CARMEL, INDIANA 46032 PO BOX 679 CHECK AMOUNT: $380.00 NASHVILLE IN 58559 CHECK NUMBER: 192122 CHECK DATE: 11/23/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 996267 150.00 EMPLOYEE PEN BENEFI 601 5023990 996329 230.00 EMPLOYEE PEN BENEFI Indiana Rural Water Association jPO Box 679 Nashville, IN 47448 ATTN: ACCOUNTS PAYABLE Invoke BILL TO DATE INVOICE NO_ City of Carmel 11/17/2010 996329 345 W 131 st St. Carmel, IN 46032 Membership Renewal Date 2/17/2011 Questions? Marylane Miller, Office Manager P.O. No. TERMS Telephone 812 -988 -6631 Fax 812- 988 -6961 Due on receipt DESCRIPTION AMOUNT IRWA Water Institute, December 6 -8, 2010 in Columbus, IN 0.00 Tuesday /Wednesday Jaimie Foreman 50.00 Tuesday Only William Bell, Brian Tolan, Tim Vandergriff 120,00 Meals TL (4) 60.00 11117 Fax 317 733 -2053 Credit Card payments accepted: Credit Card Visa MC Disc Am Exp Exp: Security Name on Card: Signature: Total $230.00 REGISTRATION FORM -IRWA Water Institute 2010 Please print or type one form for EACH ATTENDEE! First time attendee? Attendee Information: Billing Information: Name ,W t 1' r q Wl I T Company Name: c/.L rYY�� I Title Billing Contact _Ki zt^ Spouse's nam e if attending Address s `T 5(- app E S I __1 f Address 3 `C U 6 W �3 1 City Car f n-.e_1 St �I�zip _�4(OCE? Cit A St Zip 4 Telephone J Telephone 7B okf' Fax 3/7° 733 o26.0 Fax 1 7 '7 fs E -mail Lj b,&- f C:[} 1 t 1 ►y, Cyr E -mail invoice af�m, (1 1( I will be submitting contact hours for Please pnnt dearly Water Wastewater None 11 Purchase Order MONDAY SESSIONS IRWA Member Non Member Emergency Response (8:00a Noon) $25.00 $50.00 Backflow Cross Connection (8:00a Noon) $25.00 $50.00 Well Drillers Pump Installers (9:00a 4:00p) $25.00 $50.00 Small Systems Your System Responsibilities (1:00- 5:00p) $25.00 $50.00 Wastewater Sessions (1:00p 5:00p) $25.00 $50.00 TUESDAY WEDNESDAY SESSIONS IRWA Member Non Member Tuesday Wednesday $50.00 $90.00 General/Technical Sessions Board /Mgmt Utility Business Forum DO CL Tuesday ONLY $40.00 $80.00 0 Genera l/TechnicaI Sessions Board /Mgmt Utility Business Forum Wednesday ONLY $25.00 $50.00 General/Technical Sessions u 01 u MEALS Monday Lunch Tuesday Lunch Tuesday Reception Attendee $15.00 Attendee $15.00 Attendee No Fee Spouse $15.00 Spouse $15.00 Spouse No Fee One BOARD MEMBER or MAYOR per system is NO CHARGE Please check if planning to attendt entitled to (1) COMPLIMENTARY Tuesday Lunch MARILYN GAMBOLD EDUCATION FUND DONATION (MGEF) Mon Tues /Wed Lunch J'S, MGEF Mail IRWA Fax 811 988 -6961 PO Box 679 Enclosed El Credit Card Nashville, IN 47448 Visa MC Discover Amer Exp Exp.: We welcome registrations on -site. Please submit cancellation Security: requests in writing NAME ON CARD: No refunds after December 3, 2010. SIGNATURE Questions MaryJane Miller Email address for receipt: Telephone: 812- 988 -6631 E -mail: mjmmiller @att.net REGISTRATION FORM IRWA Water Institute 2010 Please ,print or type one form for EACH ATTENDEE! First time attendee? Attendee Information: Billing Informat Name T, In \tA FF Company Name: Title I /"A d� Billing Contact err✓ r LS Spouse's name if attending Address 3 q _F S t Address 3vi Li. 3 51 City ca Z, St Zip 411 City C MM St7n)_ Zip q Telephone Telephone _M -aS r Fax 31 33- a04 7 Fax E mail V C 1 r`1� e r5 t �-(r' I� C V ryN V E -mail invoice l -1 will be submitting contact hours for Please print early Water A Wastewater None Purchase Order# MONDAY SESSIONS IRWA Member Non- Member Emergency Response (8:00a Noon) $25.00 $50.00 Backflow Cross Connection (8:00a Noon) $25.00 $50.00 Well Drillers Pump Installers (9:00a 4:00p) $25.00 $50.00 Small Systems Your System Responsibilities (1:00- 5:00p) $25.00 $50.00 Wastewater Sessions (1:00p 5:00p) $25.00 $50.00 TUESDAY WEDNESDAY SESSIONS IRWA Member Non Member Tuesday Wednesdav $50.00 $90.00 General /Technical Sessions Board /Mgmt Utility Business Forum m off.. o Tuesday ONLY $40.00 $80.00 Pk General /Technical Sessions Board /Mgmt Utility Business Forum Wednesday ONLY $25.00 $50.00 Y Gene ral/TechnicaI Sessions u 6J u MEALS Monday Lunch Tuesday Lunch Tuesday Reception Attendee $15.00 Attendee $15.00 Attendee �i No Fee Spouse $15.00 Spouse $15.00 Spouse No Fee One BOARD MEMBER or MAYOR per system is NO CHARGE Please check if planning to attend! entitled to (1) COMPLIMENTARY Tuesday Lunch MARILYN GAMBOLD EDUCATION FUND DONATION (MGEF) Mon Tues /Wed 46. Lunch $J 5, 0+ MGEF r jJ• Mail IRWA Fax 812 -988 -6961 PO Box 679 Bill us Enclosed Credit Card Nashville, IN 47448 Visa MC Discover Amer Exp Exp.: We welcome registrations on -site. Please submit cancellation Security: requests in writing NAME ON CARD: No refunds after December 3, 2010. SIGNATURE Questions MaryJane Miller Email address for receipt: Telephone: 812 988 -6631 E -mail: mjmmiller @att.net O REGISTRATION FORM IRWA Water Institute 2010 Please print or type one form for EACH ATTENDEE! First time attendee? Attendee Information: Billing Information: Name f3 A O II Company Name: Title U Tor Q;__ l Billing Contact f`l W. Spouse's name if attending Address Address i-(� t A� 3 6+ City Ca&yiA�� s zip Zip i 7 City C'A/'f --�-P 1 St j Zip t4`07V -73:, Telephone .,31 7o� 33� Fax 3i 7 Telephone ��"7- 1 Fax E -mail b �d an) �_G M e i W a G t1 E -mail invoice N 1 0 a \1 c b roe r, !!lay I will be submitting contact hours for Plea pr a dearly Water A' Wastewater None Purchase Order MONDAY SESSIONS IRWA Member Non Member Emergency Response (8:00a Noon) $25.00 $50.00 Backflow Cross Connection (8:00a Noon) $25.00 $50.00 Well Drillers Pump Installers (9:00a 4:00p) $25.00 $50.00 Small Systems Your System Responsibilities (1:00- 5:00p) $25.00 $50.00 Wastewater Sessions (1:00p 5:00p) $25.00 $50.00 TUESDAY WEDNESDAY SESSIONS IRWA Member Non- Member Tuesday Wednesday $50.00 $90.00 M General /Technical Sessions Board /Mgmt Utility Business Forum CL Tuesday ONLY $40.00 $80.00 L ,d .i a General/Technical Sessions Board /Mgmt Utility Business Forum Wednesday ONLY $25.00 $50.00 Ea Y GeneraI/Technical Sessions U MEALS Monday Lunch Tuesday Lunch Tuesday Reception Attendee $15.00 Attendee $15.00 Attendee No Fee Spouse $15.00 Spouse $15.00 Spouse No Fee One BOARD MEMBER or MAYOR per system is NO CHARGE Please check if planning to attend! entitled to (1) COMPLIMENTARY Tuesday Lunch MARILYN GAMBOLD EDUCATION FUND DONATION (MGEF) Mon Tues /Wed '4n? Lunch MGEF r Mail IRWA Fax 812 988 -6961 PO Box 679 ill us Enclosed Credit Card Nashville, IN 47448 Visa MC Discover Amer Exp Exp.: We welcome registrations on site. Please submit cancellation Security: requests in writing NAME ON CARD: No refunds after December 3, 2010. SIGNATURE Questions MaryJane Miller Email address for receipt: Telephone: 812- 988 -6631 E -mail: mjmmiller @att.net U REGISTRATION FORM IRWA Water Institute 2010 Please print or type one foan for EACH ATTENDEE! First time attendee? Attendee Infonnatio I Billing Information: Name ,u TU1Q Q 17 Company Name: it Yd or Title h i O y i Billing Contact .440 Spouse's name if attending Address Addre s City St Zip cit St_.zip p 317.7),3- Z86'5 Tele hone Telephone %51 1 I Fax I nn Au E -mail E -mail invoice X61ea t to t will be submitting contact hours for Please pearly Water Wastewater None Purchase Order MONDAY SESSIONS IRWA Member Non Member Emergency Response (8:00a Noon) $25.00 $50.00 Backflow Cross Connection (8:00a Noon) $25.00 $50.00 Well Drillers Pump Installers (9:00a 4:00p) $25.00 $50.00 Small Systems Your System Responsibilities (1:00- 5:00p) $25.00 $50.00 Wastewater Sessions (1:00p 5:00p) $25.00 $50.00 TUESDAY WEDNESDAY SESSIONS IRWA Member Non Member V Tuesda Wednesda $50.00 $90.00 r General /Technical Sessions Board /Mgmt Utility Business Forum c CL Tuesday ONLY $40.00 $80.00 Genera I/TechnicaI Sessions Board /Mgmt Utility Business Forurn m Wednesday ONLY $25.00 $50.00 Y Gene ral/Technical Sessions u a v MEALS Monday Munch Tuesday Lunch Tuesday Reception Attendee $15.00 Attendee $15.00 Attendee No Fee Spouse $15.00 Spouse $15.00 Spouse No Fee One BOARD MEMBER or MAYOR per system is NO CHARGE Please check if planning to attend? entitled to (1) COMPLIMENTARY Tuesday Lunch MARILYN GAMBOLD EDUCATION FUND DONATION (MGEF) M on Tues /Wed +Lunch +MGEF Mail 1RWA Fax 812 -988 -6961 PO sox 679 Bill us Enclosed Credit Card Nashville, IN 47448 We welcome registrations on -site. Visa MC Discover Amer Exp Exp.: Please submit cancellation Security: requests in writing NAME ON CARD: No refunds after December 3, 2010. SIGNATURE Questions MaryJane Miller Email address for receipt: Telephone: 812 -988 -6631 E -mail: mjmmiller @att.net E f ��.t tr I s d i!.1;. fir. �}..C.i.l 3.�, .W ���r r t et �n ``,ia r.� 9��i� 1 v �;�W' T i f S” ,i,'�!� ,r Indiana Rural Water Association P4 sox 679 Nashville IN 47448 ATTN: ACCOUNTS PAYABLE Invoice -T L BILL TO DATE INVOICE NO. City of Cannel 11/10/2010 996267 345 W 131 st St. Carmel, IN 46032 Membership Renewal Date 2/17/2011 Questions? MaryJane Miller, Office Manager P.O. No. TERMS Telephone 812- 988 -6631 Fax 812- 988 -6961 Due on receipt DESCRIPTION AMOUNT IRWA Water Institute, December 6 -8, 2010 in Columbus, IN 0.00 Tuesday /Wednesday Jeff Carpenter, Steve Cook, Don Simpson 150.00 11/10 E -mail kloveall @carmel.in.gov Credit Card payments accepted: Credit Card Visa MC Disc Am Exp Exp: Security i3 Name on Card: Signature: Tota $150.00 1 REGISTRATI�fV F ©RNI IRVVA Water Irlstitrate 2010 Please print or type one form for EACH ATTENDEE' First time attendee? V Attendee Information: Billing Information: �1 Name C VF E P;Q! 1 I' Company Name: iA 1" y`� e L W R'T�r Title �rJSPQC'.I`L Billing Contact hP r^(, L y i /e L Spouse's name if attending Address 3 L IS L-J 13 1 S7 f rPeT_ Address 3G�S Q CJ 1.3 S1- S'rC City F wr e L St -1� Zip 60 7 City ��4rr' �e L St _1 Zip y(0`7 Telephone 7 3_�• Telephone 7 3 7 J` a$55 Fax Fax (_3 r7) 3-3 .2 o S 3 E -mail E -mail invoice X Lvec.,LL o v I will be submitting contact hours for Please print clearly Water Wastewater None Purchase Order MONDAY SESSIONS IRWA Member Non- Member Emergency Response (8:00a Noon) $25.00 $50.00 Backflow Cross Connection (8:00a Noon) $25.00 $50.00 Well Drillers Pump Installers (9:00a 4:00p) $25.00 $50.00 Small Systems Your System Responsibilities (1:00- 5:00p) $25.00 $50.00 Wastewater Sessions (1:00p 5:00p) $25.00 $50.00 C TUESDAY WEDNESDAY SESSIONS IRWA Member Non Member Tuesday Wednesday $50.00 $90.00 J a T General /Technical Sessions Board /Mgmt Utility Business Forum c M CL Tuesday ONLY $40.00 $80.00 General /Technical Sessions Board /Mgmt Utility Business Forum to M Wednesday ONLY $25.00 $50.00 General /Technical Sessions u a u MEALS Monday Lunch Tuesday Lunch Tuesday Reception Attendee $15.00 Attendee $15.00 Attendee No Fee Spouse $15.00 Spouse $15.00 Spouse No Fee One BOARD MEMBER or MAYOR per ystern is NO CHARGE Please check it ptanning to attend! entitled to (1) COMPLIMENTARY Tuesday Lunch MARILYN GAMBOLD EDUCATION FUND DONATION (MGEF) Mon _-0 Tues /Wed SO, °c) Lunch MGEF _ac O, o V Mail 1R WA Fax 812 988 696I PO Box 679 Bill us Enclosed Credit Card Nashville, IN 47448 We welcome registrations on -site. Visa MC Discover Amer Exp Exp.: Please submit cancellation Security: requests in writing NAME ON CARD: No refunds after December 3, 2010. SIGNATURE Questions MaryJane Miller Email address for receipt: Telephone: 812 988 -6631 E -mail: mjmmiller @att.net U���' REOISTR�,,�ION� FORM 1Rl�IA Water Institute 2414 Please print or typ one form for EACH ATTENDEE! First time attendee? Attendee Information: Billing Information: Name rJ .S pso N Company Name:: A r pn e t! W A T•er Title ,,,.,s -ec'To r- Billing Contact <V rcl O A_(_ Spouse's name if attending Address 3 '/SC) 131ST S-1-ree-1 Address 3 Q 5,T-e r Zip I City r r e Z_ St ri.! 7 City ¢PcMc� L yy��Stt Zip fo0� Telephone 3/2) 7 Telephane3 ZQJ�Fax 7 7.35 as s: Fax (317) 7 3-3 .2 O S 3 E -mail E -ma it invoice Lovec I will be submitting contact hours for Please print clearly Water X Wastewater None Purchase Order MONDAY SESSIONS IRWA Member Non Member Emergency Response (8:00a Noon) $25.00 $50.00 Backflow Cross Connection (8:00a Noon) $25.00 $50.00 Well Drillers Pump Installers (9:00a 4:00p) $25.00 $50.00 Small Systems Your System Responsibilities (1:00- 5:00p) $25.00 $50.00 Wastewater Sessions (1:00p 5:00p) $25.00 $50.00 TUESDAY &WEDNESDAY SESSIONS IRWA Member Non Member Tuesday_& Wednesday $50.00 $90.00 So General /Technical Sessions Board /Mgmt Utility Business Forum C �o n Tuesday ONLY $40.00 $80.00 T General /Technical Sessions Board /Mgmt Utility Business Forum ro Wednesday ONLY $25.00 $50.00 l�] General /Technical Sessions v d v MEALS Monday Lunch Tuesday Lunch Tuesday Reception Attendee $15.00 Attendee $15.00 Attendee No Fee Spouse $15.00 Spouse $15.00 Spouse No Fee One BOARD MEMBER or MAYOR per system is NO CHARGE Please check if planning to attend! entitled to (1) COMPLIMENTARY Tuesday Lunch MARILYN GAMBOLD EDUCATION FUND DONATION (MGEF) Mon Tues /Wed So Lunch MGEF _er�_ 5 Q. U Mail IRWA Fax 812- 988 -6961 PO Box 679 1 Bill us Enclosed Credit Card Nashville, IN 47448 Visa MC Discover Amer Exp Exp.: We welcome registrations on -site. Please submit cancellation Security: requests in wri ting NAME ON CARD: No refunds after December 3, 2010. SIGNATURE Questions MaryJane Miller Email address for receipt: Telephone: 812 988 -6631 E -mail: mjmmiller @att.net REGISTRATION FORM IRWA Water Institute 2010 Please rinf or LZpe one form for EACH ATTENDEE! First time attendee? Attendee Information: Billing Information: Name m at? ✓e Con K P y L G� A'T�t QRr- Com an Name: f y� e Title (JoTet' Billing Contact K e'r`( Lo L Spouse's name if attending N Address Address 3`1501) 131 S'1 rPr'T /I r City r er e" e L St Zip (hL 7 City 0,4r L St Z� Zip 1(07'7 Telephone 0) Telephone 7 3 5 Fa �7���r�Ca �Jj Fax (_3o) 7 33 c7 S 3 E -mail E -mail invoice k Lss y e c�, L L _(2� C e-r, N Q 0 V I will be submitting contact hours for Please print clearly Water Wastewater None Purchase Order MONDAY SESSIONS IRWA Member 'Non- Member Emergency Response (8:00a Noon) $25.00 $50.00 Backflow Cross Connection (8:00a Noon) $25.00 $50.00 Well Drillers Pump Installers (9:00a 4:00p) $25.00 $50.00 Small Systems Your System Responsibilities (1:00- 5:00p) $25.00 $50.00 Wastewater Sessions (1:00p 5:00p) $25.00 $50.00 TUESDAY &WEDNESDAY SESSIONS IRWA Member Non Member Tuesday Wednesday $50.00 $90.00 _S o General /Technical Sessions Board /Mgmt Utility Business Forum C M CL Tuesday ONLY $40.00 $80.00 General /Technical Sessions Board /Mgmt Utility Business Forum M Wednesday ONLY $25.00 $50.00 m Y General /Technical Sessions u d u MEALS Monday Lunch Tuesday Lunch Tuesday Reception Attendee $15.00 Attendee $15.00 Attendee No Fee Spouse $15.00 Spouse $15.00 Spouse No Fee One BOARD MEMBER or MAYOR per system is NO CHARGE Please check if planning to attend! entitled to (1) COMPLIMENTARY Tuesday Lunch MARILYN GAMBOLD EDUCATION FUND DONATION (MGEF) Mon -0'_ Tres /Wed SO. Lunch _-0 MGEF Mail IRWA Fax 811 988 -6961 PO Box 679 IN Bill us Enclosed Credit Card Nashville, IN 47448 We welcome registrations on -site. Visa MC Discover Amer Exp Exp.: i Please submit cancellation Security: requests in writing NAME ON CARD: No refunds after December 3, 2010. SIGNATURE Questions MaryJane Miller Email a_ddre_ss for receipt: Telephone: 812 988 -6631 E-maif. I Il L VOUCHER 103282 WARRANT ALLOWED 351464 IN SUM OF INDIANA RURAL WATER ASSOCIATIO P.O. Box 679 Nashville, IN 47448 WAS OPEAA710NS Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 996267 01- 6040 -05 $150.00 Voucher Total $0 Cost distribution ledger classification if claim paid under 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 of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 351464 INDIANA RURAL WATER ASSOCIATION Purchase Order No. P.O. Box 679 Terms Nashville, IN 47448 Due Date 11/15/2010 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 11115/201( 996267 $150.00 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 Date Officer