192369 12/07/2010 CITY OF CARMEL, INDIANA VENDOR: 010025 Page 1 of 1
ONE CIVIC SQUARE AMERICAN BACKFLOW PREVENTION A CHECK AMOUNT: $65.00
CARMEL, INDIANA 46032 INDIANA CHAPTER
o 2695 AIRPORT ROAD CHECK NUMBER: 192369
CENTERVILLE IN 47330
CHECK DATE: 12/712010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 12110 65.00 OTHER EXPENSES
q �at,
AMERICAN BACKELOW PREVENTION ASSOCIATION
.4
00. O
e flan A$Sri
ABPA MEMBERSHIP APPLICATION
To join the American Backflow Prevention Association, simply fill out the membership application form and mail it with
your check to the address listed below, or if paying by credit card you may fax the completed form to 979.846.7607. Local
chapters have additional fees. Below is a listing of chapters by region. To find out if there is a local chapter in your area
please review the chapter information on our website at abpa.org or call the National Office at 979.846.7606.
Membership in the Association constitutes paying National dues.
US Membershi $60.00 International Membership $74.00 ❑Affiliate Organization $300.00
Title: l7( G�C ��l�w.� C �0�5 ClIfI O- JI-o -1
Company Name: l� 0� .CLrmk,L
Address: 3q 5O Q j Sk
City:
State: s��:�e� Zip /Postal Code:
Work phone l�) r� �S"� Fax
E -mail address: (YZt a �O�C''t`n�� 1 r�� SDJ
Local Chapter (if joining a local chapter): Local Dues:
Total Amount Paid: AkS o (remit US 3 drawn on a US bank, payable to the ABPA)
New Member Renewal
If paying by credit card include the following and fax to 979.846.7607:
Credit Card No.: Expiration Date:
Name as it app arrssnon the card.
Signature f t l�' '-J
ABPA Federal ID 74- 2395100
LOCAL CHAPTER DUES LISTED BY REGION:
REGION 1 North Texas $23.00 REGION 9 (USD)
New England $12.00 San Antonio 20.00 New Brunswick $50.00
Western New York 13.00 REGION 5 Ontario 50.00
Rhode Island 18.00 Colorado $15.00 REGION 10
REGION 2 Southeastern Colorado 15.00 Wisconsin $10.00
Delaware 5.00 Utah 12.00 REGION 11
Penn State 10.00 REGION 6 Indiana =$5
REGION 3 Arizona $20.00 Indiana BPA 20.00
Carolinas $10.00 Central Coast 10.00 Michigan 37.00
Florida Suncoast 12.00 Central Valley California 10.00 Northern Illinois 23.00
Georgia 34.00 Hawaii 23.00 Ohio 10.00
Gold Coast 10.00 Silver State 23.00 Southern Illinois 23.00
Peach State "1788" 30.00 Southern California 15.00 REGION 12
Tennessee 20.00 REGION 7 Central Missouri $20.00
REGION 4 Big Sky $10.00 Eastern Nebraska 10.00
Arkansas $10.00 Idaho 10.00 Heart of America 12.00
Central Texas 20.00 Oregon 20.00 Panhandle 5.00
Corpus Christi 23.00 SRC4 20.00 Western Nebraska 8.00
Gulf Coast 23.00 REGION 8
Lower Rio Grande Valley 25.00 No Local
06.2009
PUs Ori; IcF, Box 3051 .BRYAN, TX 77805 3051.979- 846 -7606. 979 846 -7607 FAX www.abpa.org
VOUCHER 103481 WARRANT ALLOWED
TABPA IN SUM OF
AMERICAN BACKFLOW PREVENTION
PO BOX 3051
BRYAN, TX 77805 -3051 WATER
0
PER4710M
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
12110 01- 6040 -05 $65M
Voucher Total $65.00
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
TABPA
AMERICAN BACKFLOW PREVENTION ASSOC Purchase Order No.
PO BOX 3051 Terms
BRYAN, TX 77805 -3051 Due Date 12/1/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/1/2010 12110 $65.00
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