170396 04/01/2009 °c•; CITY OF CARMEL, INDIANA VENDOR: 00351022 Page 1 of 1
ONE CIVIC SQUARE JEFF FUCHS
CARMEL, INDIANA 46032 5843 DOVERTON DRIVE CHECK AMOUNT: $195.00
NOBLESVILLE IN 46060 CHECK NUMBER: 170396
CHECK DATE: 4/1/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4343002 195.00 EXTERNAL TRAINING TRA
Of CAq y
"R” CITY OF CARMEL Expense Report (required for all travel expenses)
Z71
EMPLOYEE NAM` DEPARTURE DATE: TIME: 7 PM
DEPARTMENT: v RETURN DATE: TIME: AM PM
REASON FOR TRAVELS -�R-�` DESTINATION CITY:
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT TRAVEL PE IEM t/
Date Transportation Gas/Tolls/ Lodging Meals
Parkin Misc. Total
Air -fare Car Rental Other g g g Breakfast Lunch Dinner Snacks Per Diem
$0.00
3/13/09 $60.00
3/14/09 $60.00
3/15/09 $60.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
0.00
Total $0.001 $0.001 $0.001 $0.001- $0.001 $0.001 $0.00
DIRECTOR'S STATEMENT: I h re affirb7th rall ex uses ist cnhform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date. MAR 2 O 2009
City of Carmel Form ER06 Revision Date 3/20/2009 Page 1
U. S DEPARTMENT OF HON4ELAND SECURITY O.,II.B. No. 1660 -0007
FEDERAL EMERGENCY N1ANAGEMENf See Reverse for
Privery Act Slutanent Expires February ?8, 200
GENERAL ADITILSSIONS APPLICATION SHORT FORM
USE THIS MUM ONLY IF APPLYING FOR NFA OFF CANIPUS COURSES (E<YCLUDIAIGREGIOAAL DELIVERIES)
SECTION I GENERAL INFORMATION
1. DATE OF BIRTH (Mo. Day, 2. SEX
Yr.) 12- Z Female Male 3. U. S. CITIZEN L] N
Yes o If No, City and Country of Birth:
Z
4a. ETHNICITY 4b. RACE (Please check all that apply)
1. HISPANIC or LATINO 1. AMERIC WDLAN or ALASKA NATIVE 2. ASWV 3. BLACK or AFRICAN A.%tERIC
2. NOT 1-11SPAN3C or LATINO a. W n 5. NATIVE HAWAIIAN or PACIFIC ISL UWDER
5. PLEASE PRINT YOUR NAME (Last, First, Middle, Suffix) 6. SOCIAL SECURITY NO
7. MAILING ADDRESS (Street, avenue, road no., city or town, and zip code) 3. WORK PHONE N0.
5/z�S /Vo 7'Uc] C/13 1 9. HONE PHONE NO. 31 7 6
lo. FAX No. C
�7•i �r/ Y
11. EMAIL ADDRESS
12a. EATER COURSE CODE AND TITLE 12b. COURSE LOCATION 12c. COURSE DATE
;7 1 �i�n fG, l�l^ /S G
13_ DO YOU HAVE ANY DISABILfTIES (Includin special allergies or medical disabilities) WHICH WOULD REQUIRE SPECIAL. CONSIDERATION DURING YOUR
ATTENDANCE AT NETC or NnVEAC7 NOR YES (If yes builcate describe any special considerations required wr a separate sheet)
SECTION I I ENIPLOYN'1E!NT hNFORNIATION
14a. NAINIE AND COMPLETE ADDRESS OF ORGANIZATION BEING REPRESENTED lob NFIRS# 15. CURRENT POSITION AND NUMBER
""'-X 1 Yee (IN ONLY) OF YEARS rN POSITION
2 cl v: c 51 �i(, a 3 Z
L i -s
16. CHECK THE SOX(S) BELOW THAT BEST DESCRIBE YOUR ORGANIZATION l6 b. ORGANIZATION 16c. CURRENT STATUS
16a. JURISDICTION
1. ALL CAREER I. g PAID FULL TWE
1. STATMNIDE 4- SP£CIALDISTRICT /TOW',1SHIP/ FOREIGN' 7 AL NATION ALL VOLUNTEER 2, PAID PART TENIE
2. COUNTY GOVERNMENT 5. FEDERAL.RIILITARY (non -DHS) 3. DHSrFEMA 3. COMBINATION 3. VOLUNTEER
3. CITY/TOWN ILLAGE 6 NDUSTRY)BUSLNESS 9. NDER'IM.A 4. DISASTER RESERVIST
SECTION III ENDORSEMENT AND CERTIFICATION
17a. I certify that the information recorded on Otis application is correct. Falsification of information wilt result in denial of a course certificate and stipend (U.S.C. 1001).
17b. I hereby authorize the release of any and all infomration concemin, my enrollment in this course to Ole chief officer in charge, or designee, of my organization. At[
requests for information shall be in writing from said chief officer or designee.
17c. Further, I understand that National Emergency Training Center (NE`I'C), the Mt. Weather Emergency Operations Center (MIWEOC), and the Noble Training Center
(NTC) are not authorized to provide medical or health insurance for students. I maintain appropriate insurance on an individual basis.
17d I agree to abide by the rules, policies, and regulations of NETC, NRVEOC and NTC. Failure to do so will result in denial of the student stipend, expulsion from the
course, and possible barring from future National Fire Academy (NFA) and Emergency Management Institute (ENin courses.
13a. SIGNATURE OF APPLICt 13b. DATE
0. APPROVAL BY HEAD OF THE SPONSORING ORGANIZATION (IR'OT R z4U,:?FD FOR SELF STUDY P59G L4.tifS)
By signin is application, I certify dial my organization does not discriminate on the basis of age, sex, race, color, religious belief, national origin, economic status, or
disability jpro d g educational opportunities for its rjrrployees.
19a. SIG 19b. PRINTED NANIE AND TITLE 19c, DATE
1 c
20. DITIONAL ENDORSEME] rS FOR APPLICA lON TO THE EMERGENCY MANAGEMENT INSTITUTE (NOT R& U,RRD FOR SsL. STUDYPROGR.aVS)
20a, SIGNATURE AND DATE (State Office) 20b. SIGNATURE AND DATE (FEMA Regional Office)
21. SUBMIT APPLICATION TO APPROPRIATE SPONSOR
FENIA Form 75 -5A, FEB 04 REPLACES ALL PREVIOUS EDITIONS
22a. DISPOSITION 22b. SIGNATURE OF REVIEWER 22c. DATE
ACCEPTED REJECTED
EQUAL OPPORTUNITY STATEMENT
NFA and EMI are Equal Opportunity institutions. They do not discriminate on the basis of age, sex, race, color, religious belief, national origin, or
disability in their admissions and student related procedures. Both schools make every effort to ensure equitable representation of minorities and
women in their student bodies. Qualified minority and women candidates are encouraged to apply for all courses.
PRIVACY ACT STATEMENT
GENERAL This information is provided pursuant io Public Law 93-579 (Privacy Act of 1974), Title 5 United States Code (U.S.C), Section
552a, for individuals applying for admission to NFA or E�II.
AUTHORITY Federal Fire Prevention and Control Act of 1974, as amended, Title 15 U.S.C., Sections 2201 et. seg. Robert T. Stafford
Disaster Relief and Emergency Assistance Act, as amended, Title 42 U.S.C., Sections 5121 et. seg. Title 44 U.S.C., Section 3101; Executive
Orders 12127, 12148, and 9397; Title VI of the Civil Rights Act of 1964; and Section 5044 of the Rehabilitation Act of 1973.
PURPOSES: To determine eligibility for participation in NFA and E101 courses. Information such as age, sex, and ancestral heritage are used
for statistical purposes only.
USES: Information may be released to: 1) FEMA staffto analyze application and enrollment patterns for specific courses, and to respond to
student inquiries; 2) a physician to provide medical assistance to students who become ill or are injured during courses; 3) Members of the Board
of Visitors for the purpose of evaluating programmatic statistics; 4) sponsoring states, local officials, or state agencies to update /evaluate statistics
of NFA and EMI participants; 5) Members of Congress seeking first party information; and 6) Agency training program contractors and
computer centers performing administrative functions.
EFFECTS OF NONDISCLOSURE -Personal information is provided on a volunteer basis. Failure to provide information on this form,
however, may result in a delay in processing your application and/or certifying completion of the course.
Information Regarding Disclosure of Your Social Security Number Under PL 93 -579, Section 7(b) E.O. 9397 authorizes the collection of
the SSN. The SSN is necessary because of the large number of individuals who have identical names and birthdates and whose identities can
only be distinguished by the SSN. The SSN is used for record keeping purposes, i.e., to ensure that your academic record is maintained
accurately. Disclosure of the SSN is voluntary. However, if you do not provide your SSN, another number will be substituted, which will delay
processing of your application or course certificate.
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 6 minutes per response. The burden estimate includes the time for reviewing instructions,
searching existing data sources, gathering and maintaining the needed data, and completing and submitting the form. You are not required to respond
to this collection of information unless a valid OMB control number is displayed in the upper right comer of this form. Send comments regardirmg the
accuracy ofthe burden estimate and any suggestions for reducing the burden to: Information Collections Management, U. S Department of Homeland
Security, Federal Emergency Management Agency, 500 C Strect, SW, Washington, DC 20472, NOTE: Do not send your completed form to this
address.
LMMMM=
Indiana Firefighter Training System
Indiana. Department of Homeland Security
302 W. Washington St. Indianapolis, IN 46204
February 2, 2009
All Registered Attendees for 2009 NFA Weekend Trip
Re: Trip informational letter
This letter will inform you what you will need to know for this year's trip out to the
National Fire Academy. I first want to welcome you and I am looking forward to seeing
you on the trip. We hope to have a good trip and all of you have a good experience out at
the academy. Along with this letter I have attached the welcome package information
from the NFA -EMI. If you have any questions on the trip, please contact me.
Travel
This year we have three buses to transport attendees out to the academy. One bus will
leave from just west of the Auburn Fire Department in Auburn, IN. You need to park in
the C &A Tool lot, address is 1015 West 15` Street, Auburn, IN. The bus will leave at
6 :00 am on March 13 Please be on the bus and ready to go by 6:00 am.
There are two buses leaving from Greenfield Fire Department, 17 West South St.,
Greenfield, IN. The buses will leave at 6:00am on March 13th. Park in the parking lot
to the west of the fire station. Please be on the bus and ready to go by 6:00am.
The buses will stop twice on the way out and on the way back. You may want to pack a
snack for the trip. The buses have DVD players on board so if you have movies for the
trips please bring them. Make sure you have signed for a bus if you plan to ride. If you
change plans please let me know.
Dress Code
The NFA has a dress code and will enforce it. All students must rN ear shirts with
collars when attending classes. No sweatshirts can be worn in the classes. Shirts can be
uniform, button down, or polo style shirts as long as it has a collar. Dress jeans or casual
pants can be worn, NO sweat pants or shorts. There is no need for Class A or formal
dress clothes. Dress for the weather as you will be outside at times while on the trip to
the academy.
Arriving at the NFA
All attendees will need to have a state issued photo ID (Driver Licenses) with them. You
need to report to Building "C" once you arrive on campus for check -in. You will be
assigned your room and receive your meal ticket at registration. You are eligible to eat
dinner at the academy on Friday evening.
There will be a Mandatory Informational Meeting at 6:00 pm in building "J
EVERYONE must attend!
Cancellations
If you must cancel your trip, you need to contact me. Anyone registered for the trip and
is a No Show will be charged $100.00 process fee and not be allowed to attend any NFA
EMI courses for three years.
Course Notice
For those of you who signed up for the "Fire Behavior in a Single- Family Residence" or
"Comprehensive Fire Protection Approach in a Commercial Property" courses, the NFA
staff has informed me that the two -day course material has not arrived yet. These courses
will be one day courses and you will be able to complete both courses in one weekend.
You do not need to do anything extra. Further information will be provided at the
informational meeting on Friday evening.
Cell phones use and texting while in class
All phones must be turned off or muted while in class. No one will be allowed to text
while in a class. Please advise your people that you will be unavailable during class time
and you will return calls and texts at a later time. You may give them my phone number
and they may contact me if there is an emergency and they need to reach you.
Contact information
My contact information is as follows.
Steve Walters, NFA State Representative
Office 317 -232 -2447
Cell phone 317 -695 -1616
Email swaltersga dhs.in.
While on the trip I want to remind you are representing your fire department and as a
group you are representing the State of Indiana. We ask that everyone be responsible and
professional while on the trip. This trip is a great opportunity for you to experience the
National Fire Academy.
The 2009 Indiana NFA Weekend Trip is funded by the National Fire Academy and the
State of Indiana through the State Firefighting Training Grant.
Thanks
Steve Walters
State NFA Representative
State Firefighting Program Manager
Indiana Department of Homeland. Security
2009 Indiana
National Fire Academy
Weekend Trip
March 14 15, 2009
On the campus of the National Fire Academy,
Emmitsburg, Maryland
This year's trip will be sending 180 students to the National Fire Academy
for a weekend trip FREE of charge. Course registration, rooms, and bus
transportation will be provided at no charge to students. Don't miss out on
this year's wonderful trip. The weekend trip offers a great opportunity to
see the NFA and attend some great classes with great instructors.
NEW this year, we will have three buses. Two buses will leave Greenfield
and one bus will leave Auburn Indiana on March 13' You must include
your preference in location on the bottom margin of the 75.5a application.
(You will be advised of your pickup point.) (No guarantees on location)
The buses seat 55 per bus. If you wish to drive out yourself, please
indicate on the bottom of the 75.5a application. All approved students
will receive confirmation letters and trip information by February 7 2009.
Course information class status
Command and Control of Wildland/Urban CCWUIFOSCO 30 seats open
Interface Fire Operations for the Structural 612
Chief Officer Train -tire- Trainer
Comprehensive Fire Protection Approach CFPA- 355 30 seats open
in a Commercial Property
Fire Behavior in a Single Family FBSFR 366 30 seats open
Residence
Leadership I: Strategies for Company LS I 803 30 seats open
Success
Methods of Enhancing Safety Education MESE 344 30 seats open
Courtroom Preparation and Testimony for CPTFR 209 30 seats open
First Responders
Classes will be filled, first come first served, so get your applications in!
For course details you may visit the NFA's website at
http://www.usfa.dhs.:4ov/nfa/resident/swp/index.shtm
2009 Indiana National Fire Academy Weekend Trip
Program sponsored by
Indiana Firefighter Training System
Indiana Department of onieland Security
Anyone interested in going will need to register by filling out theFE.MA
75.5a application, (please print clearly) and I it by February 1, 2009 to;
Indiana Department of Homeland Security
Attn: Steve Walters
302 W. Washington St. E-208
Indianapolis, IN 46204
APPLICATIONS MUST BE FILLED OUT COMPLETELY AND
SIGNED OFF. PLEASE PRINT CLEARLY SO WE HAVE YOUR
INFORMATION CORRECTLY.
Trip cancellations must be made by February 10, 2009 or the applicant
will be charged $100.00 and not allowed to attend future weekend's
trips for three years. (NFA rules)
For additional information on the trip contact Steve Walters, State
Firefighter Training Program Manager at 317-232-2447 or
swaltersg hs.in.gov
The course is free, rooms are free, bus ride is free, and you eat for free while
you are at the NFA. How great is that?
MARK YOUR CALENDAR TODAYV,.
Join us for the Indiana Weekend at the National Fire Academy. This setting will allow students from
various parts of Indiana the opportunity to interact together in the classroom.
All classes will be filled on a first come first
serve basis.
Return the completed application via fax to: (317) 234-0736
or via regular ma by Feb. 1, 2009
VOUCHER NO. WARRANT NO,
ALLOWED 20
Jeff Fuchs
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 43- 430.02 1 hereby certify that the attached invoice(s), or
1120 43- 430.02 "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
�G� c
MAR, 3,0;2049
.N N
t
1
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))
Indiana Weekend Per Diem $180.00
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
20
Clerk- Treasurer