177561 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 013514 Page 1 of 1
ONE CIVIC SQUARE APCO INTERNATIONAL, INC
s,. CARMEL, INDIANA 46032 351 N WILLIAMSON BLVD CHECK AMOUNT: $459.00
DAYTONA BEACH FL 32114 -1112
CHECK NUMBER: 177561
CHECK DATE: 9/29/2009
DEPARTMENT ACCOUNT PO NUMBE INVOICE NU MBER AMOUNT DESCRIPTION
1115 4357004 459.00 EXTERNAL INSTRUCT FEE
y t f i l 6
aiatl A
s
Emergency Medical Dispatch Instructor
Location Indianapolis, IN (hosted by Hendricks County Comm, Center)
Date: November 16 20, 2009
Time: 8:00 AM 5:00 PM
Tuition: $459.00
Course 28015
APCO Members receive a $20 discount
This course provides your agency personnel with the necessary skills and certification to present the APCO
Institute Emergency Medical Dispatcher Course within your agency. By having a qualified instructor on staff, you
control the training schedule and reduce your training costs.
The APCO Institute EMD program combines telecommunicator skills with medical issues. With this and ASTM
standards in mind, the APCO Institute requires that the course be taught by instructors with medical and
telecommunicator backgrounds. The instructor candidate who teaches the medical portions must have at
minimum, current certification as a Basic EMT under the National Standard Curriculum as set by the Department
of Transportation (DOT). Individuals who are either a current EMD or dispatch supervisor may teach the
telecommunicator portion. If one individual can fulfill both the telecommunications and medical requirements, that
person may teach the entire course alone. If not, the course must be presented by at least two qualified
individuals. Also, a current CPR Certification at any level from the AHA or ARC (or equivalent) is required.
Prerequisites:
APCO Institute Emergency Medical Dispatcher or EMD Concepts Certification
CPR Certification
Basic EMT Certification (for Candidates wishing to instruct the medical portion of the course or wishing to instruct the entire
course alone)
Completion of a formal basic telecommunicator training program
Restrictions:
APCO Institute certified EMD Instructors may not conduct classes outside their own agency. EMD programs vary from
agency to agency and APCO Institute, in accordance with the NHTSA Standard, restricts instructors to instruction in their own
agencies. Excluded from this restriction are agencies who are part of a regional system with a common medical director and
common guidecards. Contact APCO Institute for more details.
Co -host: Lodging: Lodging:
Hendricks County Comm. Center Radisson Days Inn
Stephanie Lees (317) 839 -8700 2500 S. High School Rd. 5860 Foxtune Circle West
Indianapolis, IN 46241 Indianapolis, IN 46241
Class Location: (317) 244 -3361 (317) 248 -0621
Task Force 1
8309 N. Perimeter Rd.
Indianapolis, IN 46241 To register online please visit our Web site:
http: /www.apeointi.com/ institute /schedule ret),
Contact (day of class):
William Bro (317) 3 27
APCO Institute, Inc.
351 N. Williamson Blvd.
Daytona Beach, FL 32114 -1112
888- 272 -6911 or 386- 322 -2500
FAX: 386- 322 -9766
INSTITUTE,.,
Student Registration Form
PLEASE PRINT CLEARLY, WITH BLACK or BLUE INK
STUDENT INFORMATION I
1 1 l� 0 I 11�
G�
First Name (1 Middle Initial Last Name (exactly as you want it to appe on your certificate)
�'V Vwt �o Otte v
Agency Name
Agenc Mailing Address
City qq��f pp j /1 State Zip +4
A 6 I I i o C Q K Would you like to be added to the Institute Listserv? Yes No
Email address (Regwred for Web Classes)
Agency Phone Number Agency Fax Number
Are you a member of APCO? YesC�_ No If yes, your membership number is:
(Membership will be verified in order to receive tuition discount.)
CLASS INFORMATION
C ass Namecaull name, lease) Class Number
r AAfl'A6 I Al A A K WyA�tr 1�',?6 76
Location (City and tale) Class Starting Date (Month and Day4J
Class Tuition Price 6J b 0
Online Class: add $50 Distance Learning fee
Total Tuition Price
METHOD OF PAYMENT (US FUNDS ONLY
V enclosed Mail to: APCO Class Registration
❑Purchase order COPY REQUIRED 351 N. Williamson Blvd.
❑VISA ❑MasterCard ❑Discover ❑AMEX Daytona Beach, FL 32114
OR
Card# Exp. Date Fax to: 386- 322 -9766
Card Holders Name: 3 or 4 Digit Security Code: Register now!
PUBLIC
Card Holders Address: o
I
A�
!C O
SAFETY
Signature:
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))
09/25/09 I I I $459.00
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.
APCO Institute, Inc. ALLOWED 20
IN SUM OF
351 N. Williamson Blvd.
Daytona Beach, FL 32114
$459.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1115 43- 570.04 $459.00 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
Friday, September 25, 2009
4�l—
D
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund