The URL can be used to link to this page

Home My WebLink About165686 11/12/2008 CITY OF CARMEL INDIANA VENDOR: 362146 Page 1 of 1 0 ONE CIVIC SQUARE C P E S C CHECK AMOUNT: $100.00 CARMEL, INDIANA 46032 49 STATE STREET MARION IN 2e752 CHECK NUMBER: 165686 o CHECK DATE: 11/12/2008 DEPARTMENT ACC OUNT PO NUM INVOICE NUMB AMOUNT DESCRIPTION 2200 4355300 100.00...THOMAS a i PROFE e CPESC Renewal Notice /'Y �a p Os�Es7C® 24 z0®$ ,OtiRND SEDIM�� `o JOHN GHARRITY THOMAS Amount Due: $1oo.00 11576 CREEK SIDE LANE Date Due: Dec. 31, 2oo8 CARM EL IN 46033 RETURN THIS FORM WITH YOUR PAYMENT Renewal Fee Details: #3668 .......__Annual Rate: $100.00 Years: 1 ..............Amount Due: $1 oo.00 ........................Status: Active Founding Partner Discount: Individual membership in IECA or SWCS qualifies registrants for discounted renewal fees. Eligibility for the discount is based on individual membership ONLY! Use of corporate membership by other than the corporate member may result in loss of certification. Membership will be verified. To receive the Founding Partner Discount, enter your membership mber s) below: IECA Membership (,7 SWCS Membership r� e, Professional Development Affirmation: CPESC.......... Current Period: 1r1/2oo6 12131/2oo8...... Requirement: 6o PDUs per 3 Year Period Minimum of 2 Categories Review your training log and select either YES or NO in response to the following statement: FOR THE CURRENT PERIOD, I MEET CPESC PROFESSIONAL DEVELOPMENT REQUIREMENTS: YES NO Sign and date in the space below. (See back page for explanation.) John Charrity Thomas Date Information de mark this notice with any changes to your contact in formation.) ��,�P� ate: (Pleas Business Phone: -(397j 496 t6j, Ext. Fax: (3 57 Home Phone: (317) 815 -1196 Email: ithomas @carmel.in.gov Please list any professional titles that you currently hold (for example, PE, RLA): Payment Information ENTER YOUR PAYMENT INFORMATION ON THE REVERSE SIDE OF THIS NOTICE. 49 STATE STREET MARION, NC 28752 PHONE: 828.655.1600 FAX: 828.655.1622 WWW.CESSWI.ORG /II` CESSWI D 4�P�wn l;� AN ENVIROCERT INTERNATIONAL, INC. ORGANIZATION John Gharrity Thomas CPESC# 3668 11576 Creek Side Lane Carmel, IN 46033 Payment Information (Please write legibly) RET THIS SHE WITH YOUR PAYMENT. Payment amount: (in US dollars) Payment method: Cash Check/Money Order Visa Diners Club MasterCard Make check payable to CPESC, Inc. in US funds. Credit Card Number: Expiration Date: Name of Card Holder Signature of Card Holder Address of Card Holder IMPORTANT! Check the reverse side of this form to ensure that the Professional Development Affirmation section has been signed and dated. Professional Development Affirmation Explanation Professional development is a fundamental component of the CPESC program. To complete renewal, you must sign the affirmation statement (on the reverse side of this notice) regarding your compliance with professional development requirements. Failure to renew your certification by paying the renewal fee AND signing the affirmation statement is a basis for suspension of your certification. Checking YES means that you have satisfied requirements for the current period. We will advance your PDU period by three years and issue a new ID card. Checking NO means that you have NOT satisfied the requirements for the Current PDU period. We will NOT advance your PDU period to the next three -year block. However, a new tD card will be issued if your PDU Period does NOT expire on or before December 31 of the current year. If your PDU Period expires on or before December 31 of the current year and the PDU requirement is not satisfied, we will NOT issue a new ID card and will recommend suspension to the CPESC Council according to CPESC, Inc. Policies and Procedures. If you need assistance in determining whether you have met the PDU requirements, please contact our office as shown on the reverse side of this notice. Remember, it is a violation of the Code of Ethics to knowingly provide false information to the CPESC Administrative Office. (See CPESC Certification Procedures and Standards, Article II, Section 4, Item B.2 for details.) 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 CPESC Purchase Order No. 49 State Street Terms Marion, NC 28752 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 111008 CPESC #3668 3- Yr Certification renewal ,John Thomas $100.00 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. 2a Clerk- Treasurer VOUCHER NO. WARRANT NO. C'PE SC ALLOWED 20 it Q 2t;;to 2troot IN SUM OF Marion, NC 28752 $100.00 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 n/a CPESC #3668 Z-2wv- 4355 00 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 20 IQ at Cost distribution ledger classification if Title claim paid motor vehicle highway fund