HomeMy WebLinkAbout193800 01/19/2011 CITY OF CARMEL, INDIANA VENDOR: 00353282 Page 1 of 7
ONE CIVIC SQUARE INDIANA ASSOC OF CITY ENGINEERS
6 CARMEL INDIANA 46032
ATTN CHERYL MENCSIK CHECK AMOUNT: $80.00
*a i PO BOX 273 CHECK NUMBER: 193800
LAGRANGE IN 46761
CHECK DATE: 111 912 01 1
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2200 4355300 60.00 ORGANIZATION MEMBER
Indiana Association of City Engineers
MEMBERSHIP APPLICATION AND INVOICE
For calendar year 2011.
INDIANA ASSOCIATION OF CITY ENGINEERS (IACE)
Please type or print:
Individual Name:
Last First M.I.
Aj AAp-_cc 1
Number. Street U City or Town State Zip
E -Mail Address: kA .qoV
Position or Title: .`V\-q q
City /Town /Company /Organization: 01)i,
Telephone: Fax:
Area Code Number Area Code Number
Membership Classes (Please check appropriate class and remit dues,for that class):
REGULAR MEMBER Any individual serving full time as a city or town engineer,
or serving as supervisor or director of a municipal engineering department. Regular members
may vote, serve on committees and hold office. Annual dues are $30.00.
AFFILIATE MEMBER Employees in municipal engineering departments, Public
Works Directors, Town Managers, etc. or representatives of FACT, Indiana LTAP, INDOT,
FHWA, etc., with an unbiased and sincere interest in -the Association. Note that the dues may be
waived for qualifying affiliate members with approval of the Executive Board. Affiliate
members may serve on committees but may not vote or hold office. Annual dues are $20.00.
ASSOCIATE MEMBER Vendors, consultants or other "friends" of the Association.
Associate members may participate in meetings but may not vote, serve on committees or hold
office. Annual dues are $125.00.
Make checks payable to: "IACE" and mail with this form to Cheryl Nlencsik, Executive
Secretary, [ACE, P.O. Box 273, LaGrange, IN 46761. Our Federal EIN is 35- 2132826.
Please reproduce form for applications for your employees, associates, etc.
P.4. Box 273 LaGrange, IN 46761 phone /fax (260) 463 -3045 cheryl*ityengineer.org www.cityengineer.org
Indiana Association of City Engine
a
MEMBERSHIP APPLICATION AND INVOICE
For calendar year 2011
INDIANA ASSOCIATION OF CITY ENGINEERS (IACE)
Please type or print:
Individual Name: V
Last irst M. 1.
Mailing Address: oa 0 1l \/ka Ode, D�3 I�QDLZ
Number Street City or Town State Zip
E -Mail Address: oyyc an (off C O`V p n CA/
Position or Title:
City /Town/Company /Organization:
Telephone: 24 3 to Fax: 2a
Area Code Number Area Code Number
Membership Classes (Please check appropriate class and remit dues for that class):
4 REGULAR MEMBER Any individual serving full time as a city or town engineer,
or serving as supervisor or director of a municipal engineering department. Regular members
may vote, serve on committees and hold office. Annual dues are $30.00.
AFFILIATE MEMBER Employees in municipal engineering departments, Public
Works Directors, Town Managers, etc. or representatives of IACT, Indiana LTAP, INDOT,
FHWA, etc., with an unbiased and sincere interest in the Association. Note that the dues may be
waived for qualifying affiliate members with approval of the Executive Board. Affiliate
members may serve on committees but may not vote or hold office. Annual dues are $20.00.
ASSOCIATE MEMBER Vendors, consultants or other "friends" of the Association.
Associate members may participate in meetings but may not vote, serve on committees or hold
office. Annual dues are $125.00.
Make checks payable to: "IACE" and mail with this form to Cheryl Mencsik, Executive
Secretary, FACE, P.O. Box 273, LaGrange, IN 46761. Our Federal EIN is 35- 2132826.
Please reproduce form for applications for your employees, associates, etc.
P.O. Box 273 LaGrange, IN 46761 phone /fax (260) 463 -3045 cheryl*ityengineer.org www. cityengineer.org
I ndiana Ass of'City Engineer
MEMBERSHIP APPLICATI AND INVOICE
For calendar year 2011.
INDIANA ASSOCIATION OF CI'T'Y ENGINEERS (IACE)
Please type or print:
Individual Name:
Last First M.I.
Mailing Address: 0 V\p sg,.,l k CL_VQ CA)( 1,t0 ��A 4 (0
Number Street kJCity or Town State Zip
E -Mail Address: 1(� Pl a (n ayn(12 Y 1 q (o V
Position or Title: Ain 0
City /Town/Company /Organization: n-V V(Nt 1
Telephone: Z S(] Fax: 1: �T iA 2-A
Area Code Number Area Code Number
Membership Classes (Please check appropriate class and remit dues for that class):
REGULAR MEMBER Any individual serving full time as a city or town engineer,
or serving as supervisor or director of a municipal engineering department. Regular members
may vote, serve on committees and hold office. Annual dues are $30.00.
3� AFFILIATE MEMBER Employees in municipal engineering departments, Public
Works Directors, Town Managers, etc. or representatives of IACT, Indiana LTAP, INDOT,
FHWA, etc., with an unbiased and sincere interest in the Association. Note that the dues may be
waived for qualifying affiliate members with approval of the Executive Board. Affiliate
members may serve on committees but may not vote or hold office. Annual dues are $20.00.
ASSOCIATE MEMBER Vendors, consultants or other "friends" of the Association.
Associate members may participate in meetings but may not vote, serve on committees or hold
office. Annual dues are $1 25.00.
Make checks payable to: "IACE" and mail with this form to Cheryl Mencsik, Executive
Secretary, IACE, P.O. Box 273, LaGrange, IN 46761. Our Federal EIN is 35- 2132826.
Please reproduce form for applications for your employees, associates, etc.
P.O. Box 273 LaGrange, IN 46761 phone /fax (260) 463 -3045 cheryl*ityengineer.org www. cityengineer.org
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
rAtt rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
c/o Cheryl Mencsik, Exec. Secretary
P.O.
Purchase Order No.
OX
Terms
LaGrange, IN 46761
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
n/a ern ers ip
Mike M(;Biide ("Regular Member" Status) $30. 0
NiCk Redden i Affiliate M bei" Status) $20.00
Total
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
h A!
v IN SUM OF
c/o Chery Mencs E xec. Secretary
P.O. Box 273
LaGrange, IN 46761
$80.00
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
n a nla E NG 4355300
materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund