161875 07/23/2008 CITY OF CARMEL, INDIANA VENDOR: 361534 Page 1 of 1
0 ONE CIVIC SQUARE INDEPENDENT ELECTRICAL CONTRACtWK AMOUNT: $1,540.00
CARMEL, INDIANA 46032 2131 N SHERMAN DRIVE
INDIANAPOLIS IN 46218 CHECK NUMBER: 161875
CHECK DATE: 7123/2608
D EPARTMENT A CCOU N T PO NU INVOICE NUMBER AMO UNT DESCR IPTION
^601 5023990 W0828.3 71408 1,540.00 APPRENTICESHIP
i
i
TUITION G
7
Member Tuition $545.00 per semester (2 per year)
Non-Member Tuition P -2 175. �O�er per (�2�er ��earC�
One Time Enrollment Fee $175.00 (non -reftindable fee)
Test Out Fee (per year) $150.00 "non refundable fee)
REFUND POLICY
TUITION
100% refund for cancellations prior to August 18th
75%'Ior cancellations prior to 2' class
50% for cancellations prior to class
25% for cancellations prior to 6" class
No refunds after 6"' scheduled class
TEXTBOOKS
1 00% refund prior to or on August 18, 2008
There will be no refund for books after the start of class.
Test Out and Registration Fees are Non-Refundable
TEXTBOOK FEES SUBJECT TO CHANGE
Commercial 1' Year Electrical Wiring Residential 76E $335.00
Usage of Blueprints
NEC 2008
GE Lamp Catalog
Student Manual
Calculator
Commercial 2 "d Year Electrical Systems based on NEC 2008 $215.00
NEC 2008
Usage of Blueprints
Student Manual
Commercial 3" Year TT Building Trades Printreading Part 3 $A 05,1 0 0
Usage of Blueprints
Electrical Grounding Bonding
Electrical Motor Controls 3E Workbook
NEC 2008
Student Manual
0sha 10hr First Aid-CPR Cert.
Commercial e Year Stallcup's Electrical Design 2008 $210.00
NEC 2008
Student Manual
7% Indiana Sales Tax will be added to text ew.,drefercn,e
CN°TR14L. INDIANA IEC
Indc, )nwactw, Inc. emlcvl G APPLICATION for APPRENTICESHIP
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Fuil Name: I I' l I I J �f l l I� E Date: 6 i-7
Last First Middle Name (full)
Addr
Street Add ress t Ap artmentlUnit
City A 1/0 f Sta 'Co de
Home E-mail
Phone: 7 J'L�' L� Address:
Cell Phone: P 7 Ci Social Security No.:
Emergency Name/
I Relationship: C "49
1 �c
Contact: �j'? 7�Lr.� L� i'
l M M r
J gA School: 910 To Al bt ?c to
Did you YES NO
Fro m: To graduate? De gree:
College: q g VJ.A N rila boas
Did you YES NO
From To: 19f3 gr adua te? D re
L _._I. gee:
Other:
Did you YES NO
F(om: To: raduate? Degree:
IN .°j ,s�' 1AF
Curr ent
Emp loyer: L /y�L Pho ne:
Address: 7 O 11J /3> f� G/�l f ��i f� Su ervisor. B// Ri r+ /a e 4'r
I Job Title: ��t r!�/ Ct h c Current Sala e7w
Resr onsibilities: I r1� J%f
From: 0 1 1 7 To. 1'✓ (l
Past
Emp10 er: l �r G Phone: 3%1) 334 12 2 2
Add ress: 7 9 k i Superviso //ARt -e
Job Title: t G�l�l�� a�� Starti n Salary: 2�c End ig Salary:
Res onsibilities:� s�i��� L �r C lv C-
K n: To: -31 Reason for Lea vin C P✓ C!�
Branch F rom: To:
Type
Rank at Discharge: Discha e:
i
Ifoller than honorable, explain:
This is not an application for employment! It is for IEC Apprenticeship enrollment purposes only!
porentic.eship Agreement U.S. Department of Labor
f',ce of Apprenticeship Training,
1- mlover and Labor Services Employment and Training Administration Q
i ing: This agreement does not constitute a certification under Title 29, CFR, Part OMB No. 1205 -0223 Expires: 10/31/2003
'o the employment of the apprentice on Federally financed or assisted
ns' ruction projects. Current certification must be obtained from the Bureau of The program sponsor and apprentice agree to the terms of the Apprenticeship Standards
or •nticeship and Training or the recognized State Apprenticeship Agency shown incorporated as part of this Agreement. The sponsor will not discriminate in the selection
34:. (Item 22) and training of the apprentice in accordance with the Equal Opportunity Standards in Title
y
A Statement: The information requested herein is used for apprenticeship 29 CFR Part 30.3, and Executive Order 11246. This agreement may be terminated by
m s!atistical purposes and will only be disclosed in accordance with the provision of either of the parties, citing cause(s), with notification to the registration agency, in
vacy Act, as amended. (Privacy Act of 1974) (P.L. 93 -579) compliance with Title 29. CFR, Part 29.6
�R TO BE': "COMPL'ETTED BVAPPRENTICE.�I =NOTE TO ""SPONSOR' PART A'SHOULD ONLY BEYFILEEQ :OUT BY�APPRENTICE, i=
ne !Last, First, Middle) and Address (No., Street, City, State, Zip Code) ANSWER BOTH A AND B 5. Veteran Status (mark one)
(Definitions on reverse)
[E Non-Veteran
'1 j J` L C c�C_l; i 4, a. Ethnic Group (mark one)
11 Veteran
Hispanic or Latino
-s J--V P- e [,Not Hispanic or Latino
.t j :7 6. Highest education level (mark one)
6 c. ✓r7 r 4 6' .5 b. Race (mark one or more) h
Am. Indian or Alaska native El 8 grade or less
Asian G 9 to 12' grade
ID
1� Black or African American I f
niic;e Native la.vaiian or et`-er GED I
1 )r ;ie of Birth (Mo., Day, Yr.) 3. Sex (mark one) Pacific Islc:nder High School or greater
i Z- f C5 /.IQ I (B Female White
reer linkages or Direct Entry (mark one) (Instructions on reverse)
A None Youth HUD /STEP -UP La School -to- Registered Apprenticeship
A Adult Job Corps Dislocated Worker Direct Entrv:
!1 nature of Apprentice Date 9. Signature of Parent/Guardian (if minot) Date
R T'B: T O" BE- COMPLETEQ BY'SPONSOR
on <..x (Name and address) Program No. IN040000019 11 a. Trade /Occupation (Tire work processes listed in the standards are part of
this agreement)
or Name and Address (No., Street, City, County, State, Zip Code) Electrician
E'ntral Indiana IEC 11b. Occupation Code 12. Term 13. Probationary Period
31 N. Sherman Drive
AIMS: (His., Mos.. Yrs.) (Hrs., Mos., Yrs.)
'1
t1dianapolis, IN 46218 0159 576/8000 12 mos.
14. Credit for previous 15. Term remaining 16. Date apprenticeship
experience (Hrs., Mos., Yrs.) (His.. Mos.. Yrs.) begins (Indenture date)
0 576/8000
ielated Instruction 17b. Apprentice wages for Related Instruction 17c, Related Training Instruction Source
n iinber of hours per year) Will be paid
1 44 min. Will not be paid
4,)prenticeship Wages: (Instructions on reverse)
Period 1 2 3 4 5 6 7 8 9 10
rm See S
Mos., Yrs.)
.rCent I
ourneyworker's or completion hourly wage 17.10 18d. Apprentice entry hourly wage
mature. of Sponsor's Representative(s) Date Signed 21. Name and address of sponsor designee to receive complaints
-v (If applicable)
T Central Indiana IEC
;nature of Sponsor's Representative(s) Date Signed 2131 N. Sherman Drive
Indianapolis, IN 46218
Et i C: T O BE-COMPLETED BY, AGENCY.`
gistraiion agency and address 23. Signature (Registration Agency) 24. Date Registered
P.pprentice Identification Number (Definition on reverse):
Privacy Act, the Records Maintenance Authority and OMB Disclosure statements, see reverse side.
l ETA 671 Rev. May 2002
I cscMra�sst t�pp�
•.ill 3,.Y•N+ t t'`�: ",.may me
AMiEND OPERATOR DRIVER LICENSE
DLNt1660-73.6225
EXPIRES: 1 211 5/2 0 09 j
AMADOU T DIALLO I
1371 LONGLEAF ST
AVON, IN 46123
OAIY OF BIRTH TRANSACTION NO. ISSUE
I1J15/1962 74150410025 02128/2007
HEIGHT WEIGHT HAIR EYES SEX
5-08 150 BLK BRO M
RESTRICTIONS pNDORSENENTS SSN
A
I
VOUCHER 082268 WARRANT ALLOWED
361534 IMP. INS I UM OF
INDEPENDENT ELECTRICAIRA
2131 N SHERMAN DR N
INDIANAPOLIS, IN 46218 tfo
*R+
r
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
�a 71408 01- 6040 -03 $1,540.00
4
vvucnCr ru�dr zti Z)4'u-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
361534
INDEPENDENT ELECTRICAL CONTRACTORS Purchase Order No.
2131 N SHERMAN DR Terms
INDIANAPOLIS, IN 46218 Due Date 7/14/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/14/2008 71408 $1,540.00
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