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Home My WebLink About200090 08/03/2011 CITY OF CARMEL, INDIANA VENDOR: 355386 Page 1 of 1 ONE CIVIC SQUARE ROSEN PLAZA HOTEL CHECK AMOUNT: $658.32 CARMEL, INDIANA 46032 9700 INTERNATIONAL DRIVE ORLANDO FL 32819 CHECK NUMBER: 200090 CHECK DATE: 8/3/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4343002 658.32 EXTERNAL TRAINING TRA ROS Reservation Phone Number: 1 -800- 627 -8258 VLAZA Reservation Fax: 407 -996 -9119 9700 International Drive, Orlando, Florida 32819 -8122 http: /www. RosenPlaza.com PLEASE VERIFY ALL INFORMATION FOR ACCURACY Guest Information: Room Total Date Stay Rate kale JEFF FUTHS $580.00 Surcharge Taxes Sunday, September 18, 2011 $145.00 4285 N. 400E Monday, September 19, 2011 $145.00 GREENFIELD, iN 46140 USA Tuesday, September 20, 2011 $145.00 Wednesday, September 21, 2011 $145.00 Home Phone: 3176958969 foxy8103 @yahoo.com Email Address: NM �M �"4 N WACCOhtIMODATIONSfREQUES�TED XP Printed On: Friday, June 17, 2011 Deluxe Double dI '1��'' ER .:e'7.:4 d F 3 Ai��. 3 'S a 3 Y ,a'�tr� a n d .a, S[ s t�:+ i, ..'V o-" .a 'emu a' 'T.. 5 ARRIVALDATE DEP,ART'D`ATEE €i3i "CON! IRMATIONi ASSOCIATEDWITH E„ z E m �-�a ...d... 09/18/2011 09/22/2011 1 RR5D2DB9 FDSOA 2011 Annual Meeting Stay Summary: of Rms 1 All rates are exclusive of 12.5% tax and 1% OCCCD Surcharge GTD: YES MAST Information that you will need to know !Sing Beds, Connecting rooms, specific locations, and other special requests noted on your reservation are not guaranteed. Rest assured every effort will be made to meet your needs. Rosen Plaza is a smoke -free facility including all guest rooms, restaurants, lounges, meeting rooms and public spaces. Designated smoking areas are available outside of the Hotel- The Hotel will apply a $350 cleaning fee for guests who disregard this policy. The Hotel has an agreement with the Orange County Convention Center (OCCC) and other properties in the Orange County Convention Center District OCCCD) to pay one percent of the room rate as a surcharge (not subject to tax exemption). The OCCCD 1% surcharge shall be used to promote the Orange County Convention Center and tourist services in the vicinity of the Orange County Convention Center District. All approved major credit debit cards will be accepted. Please note an authorization of one night's room and tax will be taken on your card five days prior to your arrival date. Debit Cards will show a debit in your account at this time. Any reservation with a declining credit or debit card will be subject to cancellation. in the event that you do not arrive on your requested arrival date listed above, the card given at the time of booking will be charged one night's room and tax. All Reservations must be cancelled at least 5 days prior to arrival in order to avoid a cancellation charge. 5 Da y C an ce ll ati on Policy M IDINE l C14,6knAC'1UE Z. JC S 2 5 t Fnjoy detightfvil, first- cl ass dirnint; C stLrrou icteLl by the world's largest collcsc,tioIY of atitogral bed celebrity c:aricntturec! SAVE 25 l� (DFF YC -)UP, CI -1 ECX !:'cat tuft-) c4 tAIZIrtcira �x 12.esrVatic)a -1S, 1 'L1�CE Cz11 1 407-996.1787 C:�C.7tt.tl VALET .t'A[Z'KtNG L Not Valid with any other o ww The Brad Brewer Academy is Here for Your Game! 407- 996 -3306 w.bradbrewer.com info @bradbrewer.com Please be aware that there are two Rosen Hotels adjacent to the Orange County Convention Center. The Rosen PLAZA is at 9700 International Drive and the Rosen CENTRE is at 9840 international Drive. Your reservation is at the ROSEN PLAZA. a a o a. t 1 s 1. x t a b n k a m m gar i° r a. 4 kY jA J� D q. W n' =o. r WART� SNFETy ti Fly �`"/CERS NS FDSOA Headquarters, P. O. Box 149, Ashland, MA 01721 Voice: 508 881 --3114 508 881 -1128 Email: membership @fdsoa.org Incident Safety Officer Certification Application Applicant shall meet requirements of NFPA 1521, 2008 Edition, Chapter 4, Section 4.5.1 Please type or print all information Name: SS# Last 4 digits: 1 Agency: Vic e a Rank: LT Department Type: Career Combination Volunteer Other Address: 5'Z. r N. 5'w C City: State Zip: �'6iye Day Time Phone: FAX: Cell Phone: Email: Professional Experience (Required) Agency Dates Position r To Employer (Required) Please verify the above information by signing below: I verify that has been involved in the emergency services for a minimum o five (5) years and meets the requirements of NFPA 1521, 2008 edition, Chapter 4, Section 4.5.1 Print Name: �`C r Required C 'ef or Chief Officer Signature: Requir d: Chie or Chief Officer Rev. 01/08 Registration Form (Register online at www.fdsoa.org) FDSOA Annual Safety Forum Pre Registration Required NOTE: Use one registration form per person photocopies accepted. Please return completed form, with payment in U.S. funds, to FDSOA, P.O. Box 149, Ashland, MA 01721 -0149. Make checks payable to FDSOA. Save time register online at: http: /www.fdsoa.org. Name: Nickname: Title: �T. a,T:.a�:n.,� Agency: Address: N. City: r�.,�,Y,n State: Zip: Day Time Phone: FAX: Cell Phone: Email: ��'z /,1 Conference Registration Fees Member Non Member Amount Safety Forum Only $325.00 $425.00 VSafety Forum ISO Academy $425.00 $525.00 5-z.s- e ❑Safety Forum HSO Academy $425.00 $525.00 ISO Academy Only $200.00 $300.00 HSO Academy Only $200.00 $300.00 WISO Certification Exam 95.00 $195.00 �5 HSO Certification Exam 95.00 $195.00 FDSOA Individual Membership Dues (Join now to take advantage of the member rated 85.00 TOTAL AMOUNT DUE Payment Information: (U.S. Funds, drawn on�U //.S. Bank) El Enclosed is a check payable to FDSOA E V Enclosed is an official Purchase Order MasterCard Visa Card Number: Expiration Date: Card Holder Signature: Date: Card Holder Name: (Please Print) Cancellations: Cancellations must be made in writing and sent to FDSOA, P. O. Box 149, Ashland, MA 01721-0149. If received 30 days prior, 75% of Forum Registration only will be refunded; 7 -29 days prior, 50% of Forum Registration only will be refunded. Less than 7 days, no refund is possible. FDSOA Non Profit Org. P. O. Box 149 U.S. POSTAGE Ashland, MA 01721-0149 PAID Permit No. 125 Ashland, MA 2011 FDSOA Annual Safety Forum HOTEL RESERVATION FORM REPLY DIRECTLY TO THE HOTEL Mail To: Rosen Plaza Hotel, 9700 International Drive, Orlando, FL 32819 (407) 352 -9700 FDSOA Room Rates: Single /Double: $135.00 Plus Tax T Cut Off Date: August 25, 2091 Arrival Date: Departure Date: NAME: v ADDRESS: �•Q� CITY: STATE: ZIP: WORK PHONE: FAX: ADDITIONAL PERSONS: Cut--Off date for reservations is August 25, 2011 Your reservations will be held until 6:00 P.M. unless accompanied by a deposit. You may also guarantee with an accepted credit card, expiration date and signature. Hold until 6:00 P.M. only Guaranteed by the following credit card: (check one) El Master Card Visa AMEX Card Number: Signature: Exp. Date Annual Conference Online Receipt Page 1 of 1 Thank you for submitting your information for the Annual Conference. Confirmation of your registration will come to you through U.S. Mail. Please call the FDSOA office at 508 881 -31 14 with any questions. Here is a summary of your submission: Name: Stephen Reeves Position: Health Safety Officer Agency: Carmel Fire Department Address: 2 Civic Square City: Carmel State: IN Zipcode: 46032 Country: USA Work Phone: 317 -571 -2600 Fax: 317- 571 -2615 Email: dsnyder @carmel.in.gov Course 3: Safety Forum, HSO Academy, HSO ,Exam FDSOA Member $520.00 Credit Card Type: PO PO Number: 12222 Submit: Submit https: /www.fdsoa.org /annconf receipt.htm 7/19/2011 VOUCHER NO. WARRANT N ALLOWED 20 Rosen Plaza Hotel IN SUM OF 9700 International Drive Orlando, FL 32818 $658.32 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO, I ACCT #/TITLE AMOUNT Board Members 1120 I 1 43- 430.02 I $658.32 1 hereby certify that the attached invoice(s), or 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 AUG 7 2 011 Fire Chief Title Cost distribution ledger classification if claim paid motor 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 service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Reeves Fuchs $658.32 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