168527 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 00353282 Page 1 of 1
ONE CIVIC SQUARE INDIANA ASSOC OF CITY ENGINEERS CHECK AMOUNT: $70.00
CARMEL INDIANA 46032 ATTN: CHERYL MENCSIK
PO BOX 273 CHECK NUMBER: 168527
LAGRANGE IN 46761
CHECK DATE: 2/4/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2200 4355300 70.00 ORGANIZATION MEMBER
MEMBERSHIP APPLICATION AND INVOICE
For calendar year 2009
INDIANA ASSOCIATION OF CITY ENGINEERS (LACE)
Please type or print:
Individual Name: kl1?
Last First M.1.
Mailing Address: 1�!1._� �Clr� _�Ll i� _:Gj 4L-o 2
Number Street City or Town State Zip
E -Mail Address:
Position or Title: Ct >1 CPC',
City /Town /Company /Organization: of CC
Telephone: 7Y1 F ax:
Area Code Number Area Code Number
Membership Classes (Please check appropriate class and remit dues for that class):
REGULAR MEMBER Any individual serving full time as a city or town engineer,
or serving as supervisor or director of a municipal engineering department. Regular members
may vote, serve on committees and hold office. Annual dues are $25.00.
AFFILIATE MEMBER Employees in municipal engineering departments, Public
Works Directors, Town Managers, etc. or representatives of IACT, Indiana LTAP, INDOT,
i "HWA, etc., With cU: Unbiased and sincere interest ill the Association. Note that the dues may be
waived for qualifying affiliate members with approval of the Executive Board. Affiliate
members may serve on committees but may not vote or hold office. Annual dues are $10.00.
ASSOCIATE MEMBER Vendors, consultants or other "friends'' of the Association.
Associate members may participate in meetings but may not vote, serve on committees or hold
office. Annual dues are $100.00.
Male checks payable to: "LACE" and mail with this form to Cheryl Mencsik, Executive
Secretary, [ACE, P.O. Box 273, LaGrange, IN 46761. Our Federal EIN is 35- 2132826.
Please reproduce form for applications for your employees, associates, etc.
MEMBERSHIP APPLICATION AND INVOICE
For calendar year 22009
INDIANA ASSOCIATION OF CITY ENGINEERS (LACE)
Please type or print:
Individual Name: tUN MN
Last First M. 1.
Mailing Address: ON L- ClVtC 5�Q_A4 44 IN 4(oo 3 2
Number Street City or shown State Zip
E -Mail Address: G d kinct,y1 l? cArn, Cj in. Q 0V
Position or Title: A %st STAn r C'tT't EN GtN ye)L
City /Town /Company /Organization: CAN of CAYW on
Telephone: 3 17 5 24+1 Fax: 317- 571-
Area Code Number Area Code Number
Membership Classes (Please check appropriate class and remit dues for that class):
l� REGULAR MEMBER Any individual serving full time as a city or town enbineer,
or serving as supervisor or director of a municipal engineering department. Regular members
may vote, serve on committees and hold office. Annual dues are $25.00.
AFFILIATE MEMBER Employees in municipal engineering departments, Public
Works Directors, Town Managers, etc. or representatives of TACT, Indiana LTAP, INDOT,
FI-IWA, etc., with an unbiased and sincere interest in the Association. Note that the dues may be
waived for qualifying affiliate members with approval of the Executive Board. Affiliate
members may serve on committees but may not vote or hold office. Annual dues are $10.00.
ASSOCIATE MEMBER Vendors, consultants or other `'friends" of the Association.
Associate members may participate in meetings but may not vote, serve on committees or hold
office. Annual dues are $100.00.
Make checks payable to: "LACE" and mail with this form to Cheryl Mencsik, .Executive
Secretary, LACE, P.O. Box 273, LaGrange, IN 46761. Our Federal FIN is 35- 2132826.
Please reproduce form for applications for your employees, associates, etc.
MEMBERSHIP APPLICATION AND INVOICE
For calendar year 2009
INDIANA ASSOCIATION OF CITY ENGINEERS (LACE)
Please type or print:
Individual Name:
Last First M.1.
Mailing Address:
Number Street City or Town State Zip
E -Mail Address: �I�I�Y'_�
Position or Title:
City /Town /Company /Organization: C� 1 1✓�
Telephone: M_ t_� I Z01 Fax: 17.. ��11 Z�f
Area Code Number Area Code Number
Membership Classes (Please check appropriate class and remit dues for that class):
REGULAR MEMBER Any individual serving full time as a city or town engineer,
or serving as supervisor or director of a municipal engineering department. Regular members
may vote, serve on committees and hold office. Annual dues are $25.00.
A AFFILIATE MEMBER Employees in municipal engineering departments, Public
Works Directors, Town Managers, etc, or representatives of TACT, Indiana LTAP, INDOT,
FHWA, etc., with an unbiased and sincere interest in the Association. Note that the dues may be
waived for qualifying affiliate members with approval of the Executive Board. Affiliate
members may serve on committees but may not vote or hold office. Annual dues are $10.00.
ASSOCIATE MEMBER Vendors, consultants or other "friends" of the Association.
Associate members may participate in meetings but may not vote, serve on committees or hold
office. Annual dues are $100.00.
Make checks payable to: "IACE" and mail with this form to Cheryl Mencsik, Executive
Secretary, IACE, P.O. Box 273, LaGrange, IN 46761. Our Federal EIN is 35- 2132826.
Please reproduce form for applications for your employees, associates, etc.
MEMBERSHIP APPLICATION AND INVOICE
For calendar year 2009
INDIANA ASSOCIATION OF CITY ENGINEERS (IACE)
Please type or print:
Individual Name: 2cctk-r N 1 o
Last First M.I.
Mailing Address: I (W) ]�p.� A�( Z_2_
Number Street City or Town State Zip
E -Mail Address:
Position or Title: p-cy�nvNi Cmr I�Q, r
City /Town/Company /Organization: C cC.t-a"
Telephone: Fax: !-1
Area Code Number Area Code Number
Membership Classes (Please check appropriate class and remit dues for that class):
-t— REGULAR MEMBER Any individual serving full time as a city or town engineer,
or serving as supervisor or director of a municipal engineering department. Regular members
may vote, serve on committees and hold office. Annual dues are $25.00.
X AFFILIATE MEMBER Employees in municipal engineering departments, Public
Works Directors, Town Managers, etc. or representatives of IACT, Indiana LTAP, INDOT,
FHWA, etc., with an unbiased and sincere interest in the Association. Note that the dues maybe
waived for qualifying affiliate members with approval of the Executive Board. Affiliate
members may serve on committees but may not vote or hold office. Annual dues are $10.00.
ASSOCIATE MEMBER Vendors, consultants or other "friends" of the Association.
Associate members may participate in meetings but may not vote, serve on committees or hold
office. Annual dues are $100.00.
Make checks payable to: "IACE" and mail with this form to Cheryl Mencsik, Executive
Secretary, IACE, P.O. Box 273, LaGrange, IN 46761. Our Federal EIN is 35- 2132526.
Please reproduce form for applications for your employees, associates, etc.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
Oft rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
c/o Cheryl Mencsik, Exec. Secretary
Purchase Order No.
OX
Terms
LaGrange, IN 46761
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1129109 n/a 2009 Membership
M ember" us
Gary Duncan ("Regular Member Status) $25. 0
Nick Redden Affiliate Member" u
Member Arnanda Foley Wiliate
Total
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
VOUCHER NO. WARRANT NO.
ff ALLOWED 20
7� S IN SUM OF
c/o Cheryl Mencsik, Exec. ecretary
P.O. Box 273
LaGrange, IN 46761
$70.00
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
Board Members
Po# or INVOICE NO. ACCT##/TITI-E AMOUNT
DEPT. 1 hereby certify that the attached invoice(s)', or
bill(s) is (are) true and correct and that the
nra nla ENG 4355300 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund