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HomeMy WebLinkAbout201258 09/13/2011 CITY OF CARMEL, INDIANA VENDOR: 365666 Page 1 of 1 ONE CIVIC SQUARE IN EMERGENCY MEDICAL SERVICES Ag CARMEL, INDIANA 46032 407 MELROSE AVENUE CFIECK AMOUNT: $250.00 GREENCASTLE IN 46135 CHECK NUMBER: 201258 CHECK DATE: 9/13/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4357004 250.00 EXTERNAL INSTRUCT FEE IEMSA Conference Registration Form Please print clearly Fill out one per attendee $125 per person (includes lunch) $100 per person IEMSA Members (includes lunch) Name of Attendee: Ile, e- rr Name as it is to appear on badge: M I' 1'� C Department Name: C 11 1Y level: Street Address: 2 di City: ('M e, State: Zip: IoO33 Telephone: 3 1 l 5 I I' 2_ P 1 Email address: �'1 rl1'L° a n 0V //11 Payment Information Total Amount Due: V0 Please send payment (check, money order or cash only —no credit cards please): IEMSA, 407 Melrose Ave., Greencastle, IN 46135. Telephone: 765- 653 -1351 Email: mbward1222nyahoo.com For those who would like to stay overnight there are numerous hotels located nearby. Below is a list of hotels and the Priceline cost for each: Homewood Suites ($116) Hampton Inn ($99) Value Place ($60) 2264 East Perry Road 2244 E. Perry Rd, 6295 Gateway Blvd., Plainfield IN Plainfield, IN Plainfield, IN (317) 839 -1900 (317) 839 -9993 hamptoninnl.hilton.com (3 17) 837 -2950 Wingate by Wyndham ($94) Baymont Inn Suites ($60) Best Western ($90) 6300 Gateway Dr. 6010 Gateway Dr. 61009 Cambridge Way Plainfield, IN Plainfield, IN Plainfield, IN (317) 279 -2500 (317) 837 -9000 (317) 837 -7500 Cbmf6rt Imn ($85)' Holiday Inn Express ($104) 6107 Cambridge Way 6296 Cambridge Way Plainfield, IN Plainfield, IN (317) 839 -9600 comfortinn.com (317) 839 -9000 hiexpress.com Staybridge Suites Plainfield ($109) 6295 Cambridge Way, Plainfield, IN (3 17) 839 -2700 staybridge.com ri IEMSA Conference Registration Form Please print clearly Fill out one per attendee $125 per person (includes lunch) $100 per person IEMSA Members (includes lunch) Name of Attendee: •',tS 2C)(U Name as it is to appear on badge: P,C'�LC/ �GZ/� r7Q/ti Department Name: ��zr�nel �`���ev� Title /Certification level: L',aC 4, nGA V Street Address: Z City: 0G�me 1 State: _J?V Zip: q603 Telephone: L3 7� S7 Z 0 5 Email address: h 0-0 n a.:, 0 C2a/ In. Payment Information Total Amount Due: Z S. U D Please send payment (check, money order or cash only —no credit cards please): IEMSA, 407 Melrose Ave., Greencastle, IN 46135. Telephone: 765- 653 -1351 Email: mbward1222(a,yahoo.com For those who would like to stay overnight there are numerous hotels located nearby. Below is a list of hotels and the Priceline cost for each: Homewood Suites ($116) Hampton Inn ($99) Value Place ($60) 2264 East Perry Road 2244 E. Perry Rd, 6295 Gateway Blvd., Plainfield IN Plainfield, IN Plainfield, IN (311) 839 190 (317) 839 -9993 hampton inn l.hilton.com (317) 837 -2950 Wingate by Wyndham ($94) Baymont Inn Suites ($60) Best Western ($90) 6300 Gateway Dr. 6010 Gateway Dr. 61009 Cambridge Way Plainfield, IN Plainfield, IN Plainfield, IN (3 17) 279 -2500 (317) 837 -9000 (3 17) 837 -7500 Comfort Inn ($85) Holiday Inn Express ($104) 6107 Cambridge Way 6296 Cambridge Way Plainfield, IN Plainfield, IN (317) 839 -9600 comfortinn.com (317) 839 -9000 hiexpress.com Staybridge Suites Plainfield ($109) 6295 Cambridge Way, Plainfield, IN (317) 839 -2700 staybridge.com 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)) $250.00 1 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 IEMSA IN SUM OF 407 Melrose Avenue Greencastle, IN 46135 $250.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 I I 43- 570.04 I $250.00 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 SEP 12 2019 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund