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176749 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 00352647 Page 1 of 1 ONE CIVIC SQUARE BRUCE GIPSON CHECK AMOUNT: $266.46 CARMEL, INDIANA 46032 1023 WOODBRIDGE CT CARMEL IN 46032 CHECK NUMBER: 176749 CHECK DATE: 9/2/2009 DEPARTMENT ACCOUNT PO NUMBER INVO N UMBER AMOUNT DESCRIPTION 1120 4343002 266.46 EXTERNAL TRAINING TRA rt i DAl E rtj DQLLARS CASH, ACCOUNT ul MONEY O FROM TO PAYME CFIECK G Aq V-2 BAL. DU CREDIT RY I I f1 q� n 1 F 4� r ln�iiara �erve�tio� Center CenferGlate T i i, r�M tarr_1: i� <r :v'=s!;r cssu r.i L9. Coffee ,i�J 0 $i b l.0 ia 1 5. 50 focal `I.20.0U t.ii �(jr III 14. 50 i b u «q i gSX'"Y F nAW 3 :R gddS q R :q Q /Zq DO :R6i'll 00 jr;"ll oo hf ilt'li oo*tlll oo 4t I oo(W"'.! PLAZA PARK O'S/22;)Q: 5t'� L# 2 A41. 7 Txn'0t 09 /09 07:10 In 08/22/09 J1.1 .56 DWI Thl 6MVG Regular Rate 16.00 Total Fee 1 6 Af,) CASH PAID 1 16AO- Cash TwOr 1100 Change Due 0.00 "'HANYOU BKC V Wi i' 1 r 0G AC ASE. s GUE ST VER DI 211 ,RSO. \v BK 16,, .)5 14125 Mund, Drive 317, 7 7 -0 -1216 28 DAKOTA Chk 232 St /VI =t D FOOD i� T `'S32P11 i;; v r,n hL�t {L JJUt{SCJ. Drive Thru, 1 Brg Shot 6PK. Chs 4,69 Md' F r BS 1 ,59 Cash 10,00 Subtotal, 6,38 Tax: 0,58 Total: 6,96 Change Due 3,04 -28 Check Closed 07:39PM HOW WAS IT? TELL US AT -1 -866 -425 -4745 CHECK'ON'BACK FOR FOOD OFFER 6@l e7 Return this receipt to a participating 04 BURGER KING® restaurant to receive offer. N Food purchase required. Validated receipt 0 good for one m kth from date of purchase. Not valid with any other offer, including L w senior or VAlue meal pricing. Not available to �1J employees their families. One survey t� per guest per month. Cash value 1 /100(;. UI r.a LLame gratis all-866-425-4745 y siga las instrucciones. One free WHOPPER® sandwich or Original Qf� Chicken sandwich with purchase of any size drink and fries after completing our brief survey. R 1. Call toll free 1- 866 425 -4745 p (M anytime within 48 hours. rn �7 2. Complete survey and get p validation code. 3. Write code here G) co Return this receipt to a participating 9-0 BURGER KING® restaurant to receive offer. d! Food purchase required Validated receipt 0 good for one month from date of purchase. up 0 a Not valid with any other offer, including J6 senior or value meal pricing. Not available to t Z employees their families. One survey to per guest per month Cash value 1 /100 (Z. Ul a LLame gratis al 1- 866 425 -4745 y siga las instrucciones. 1- 866- 425 -4745 1- 866 425 -4745 One free WHOPPER© sandwich or Original Indiana Convent i on Center Cnntorplato Ua 1 i. i r'itC, 1009 l me i i i 011AM �la'd i i_llt�t��'i p; a $4 Uu t 1; -1. UO Lash; 4.00 Cl rroe `x0.00 Rece. i p 1:: 106 1 U. 0839 7 2009 IERC Registration Form You may register using the form below. Please print /type and complete all sections of the form. Use one form per registrant; photocopy additional form(s) as needed. You may also register online at www.indfirechiefs.org. Online registration ends Wednesday, August 12. There will also be an opportunity for on -site registration on August 20 2E. Please visit www.indfirechiefs.org for more details. Badge /Registrant Information _�C v��-A-_ 0� First Name Middle Initial Last Name Spouse T Department /Company Address City State /Zip Code Phone Fax E -mail Please Circle Your Conference Registration Choice(s) Full Conference Registration (includes all meals and programs): This year we are offering registration for the golf tourney on Wednesday, August 19, in the conference registration. You may register for the golf tourney with this registration form or by visiting www.indfirechiefs.org. (Please register separately if you are registering a foursome.) w/o Golf w Golf w/o Golf w Golf Conference Participation: $150 205 Spouse Program: 110 155 *Note sign -ups after the deadline of August 12 will need to pay $200 for the Full Conference Registration without golf and $255 with golf; for the Spouse Program the fee will be $150 without golf and $195 with golf. Spouse Program includes Wednesday night event, Thursday and Friday Spouse Program, Thursday evening events, Friday breakfast and banquet. Please provide all contact information including e -mail address for your spouse. We will be sending out Spouse Program information. Spouse Name and E -mail Address Single Day Registration: Can't get away for the entire conference? Join us Thursday, Friday or Saturday for great activities and educational sessions. Single Day: $85 Pre Conference Workshops: $40 Saturday American Heart Association Provider Course: $40 *Note sign -ups after the deadline of August 12 will need to pay $100 for a Single Day Registration. Banquet Functions circle choice(s): Single tickets available for individual(s) wishing to attend the following events: (please check which event) Please note that these functions are included with a Full Conference Registration. The following are for those only wanting to attend these events and nothing else. Thursday Evening Buffet and Casino Night: $40 /person Friday Night Banquet: $40 /person Total Amount /Method of Payment Total Amount: Account Number: Exp: (for registration, activities and banquet fees) Payment by credit card: (circle one) Name as it appears on card: Visa MasterCard Signature: Payment by Check: Make check payable to IFCA and mail completed Cancellation Policy: Refunds, less a $25 reservation form with payment to: Indiana Emergency Response Conference, administrative fee, will be made upon written P.O. Box 364, Zionsville, IN 46077. Forms may be faxed if payment is by credit notice of cancellations postmarked by July 25, card. Fax to: 317 733 -4212. Questions? Call Terry Rake at 317- 733 -1850. 2009. No refunds will be given after July 25. 2009 IERC Hotel Reservation Form To secure your hotel reservation, please complete the following form (PRINT CLEARLY): Name Company /Department Address Telephone E -mail Date of Arrival Date of Departure Special Requests Please select which type of room you prefer, as well as the number of rooms required: Room Type Rate Number of Rooms Total Single Occupancy $113 /night Double Occupancy $113 /night Triple Occupancy $138 /night Quadruple Occupancy $163 /night Add 16% Sales Tax Grand Total Payment Information: Check Number (Please make checks payable to Indiana Fire Chiefs Association) or Credit Card: (circle one) Visa MasterCard Name as it Appears on Credit Card: Card Number: Expiration Date: Cardholder Signature: Mail your payment to: PO Box 364 Zionsville, IN 46077 Forms may be faxed or e- mailed if payment is by credit card. Fax to: 317- 733 -4212 E -mail to: rake @indfirechiefs.org 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)) $200.00 $6.96 $4.00 $2.50 $14.00 $20.00 $16.00 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Bruce Gipson IN SUM OF �dtv $26646 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO, ACCT #/TITLE AMOUNT Board Members 1120 43 430.02 $200.00 1 hereby certify that the attached invoice(s), or 1120 43- 430.02 $6.96 bill(s) is (are) true and correct and that the 1120 43- 430.02 $4.00 materials or services itemized thereon for 1120 43- 430.02 5 5a L. 1120 43- 430.02 $14.00 which charge is made were ordered and 1120 43- 430.02 $20.00 received except 1120 43- 430.02 $16.00 A 3 1 7009 r r s Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund