HomeMy WebLinkAbout194377 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 365043 Page 1 of 1
ONE CIVIC SQUARE THE GROUNDWATER FOUNDATION CHECK AMOUNT: $72.50
CARMEL, INDIANA 46032 PO BOX 22558
•4. LINCOLN NE 68542 CHECK NUMBER: 194377
CHECK DATE: 2/3/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 13111 72.50 OTHER EXPENSES
0 2011 Groundwater Foundation Membership and
Groundwater Guardian Administrative Fee Contribution
Please complete and return this form, along with your Annual Entry paperwork and check or credit card
information, by February 15 for Groundwater Guardians designated the previous year; new
Z; Groundwater Guardians may submit at any time to:
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C O
The Groundwater Foundation, P.O. Box 22558, Lincoln, NE 68542 -2558
Payment can also be submitted online at http: /www. groundwater. org /shop /categories.asp ?cat =18.
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Team Contact !Name:
Groundwater Guardian Team: (2 nailla a�x I I
We are a Groundwater Guardian: Community O
Mailing Address:
City, State, ZIP, Country:
Phone: Fax:
Email address:
*You may also contribute as a G undwater Foundation member with this form.
Groundwater Guardian Administrative Fee
O $100 1st year Community
i $75 Renewing Community (only $37.50 if submitted with Annual Entry paperwork by February 15, 2011)
O $200 1st year Affiliate
O $150 Renewing Affiliate (only $75 if submitted with Annual Entry paperwork by February 15, 2011)
Membership Options
1 ya`�+. $35 74 (Ripple Creator) O $75 —149 (Cool Springs Contributor)
O $1S0 249 (Big Splash Supporter) O $250 499 (Hydro Hero)
11 $500-999 (Groundwater Defender) 0 $1,000 2,499 (Awesome Aquifer Advocate)
C3 $2,500 (Blue Planet Protector)
Groundwater Guardian Benefits
Total Payment:
A monthly newsletter with
Payment options program information and
updates, funding opportunities,
O Please charge my VISA or MasterCard for the amount of activity ideas, success stories,
and more
Card number: Access to case studies of
Expiration date: 3 digit security code: successful activities_
Opportunities to connect to
The following information must be provided as it appears on your credit card other Groundwater Guardians
statement, otherwise we will be unable to process your request. Personalized news releases
Cardholder's name: Discounted or free access
to Groundwater Foundation
Organization's name: webinars
Address: A 10% discount on Groundwater
catalog products
City, State, Zip:
All membership dues are tax
Authorized Signature: deductible (the Groundwater
Guardian administrative fee is not).
Enclosed, please find a check made payable to The Groundwater Foundation,
for the amount of a --3r Federal Tax ID# 36- 3413351
VOUCHER 103938 WARRANT ALLOWED
365043 IN SUM OF
THE GROUNDWATER FOUNDATION
PO BOX 22558_
LINCOLN, NE 68542 -2558 WA`M
ORER4776w
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
13111 01- 6750 -03 $72.50
Voucher Total $72.50
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
365043
THE GROUNDWATER FOUNDATION Purchase Order No.
PO BOX 22558 Terms
LINCOLN, NE 68542 -2558 Due Date 1/27/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
112712011 13111 $0.00
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