HomeMy WebLinkAbout180388 12/16/2009 CITY OF CARMEL, INDIANA VENDOR: 363633 Page 1 of 1
ONE CIVIC SQUARE C P E S C CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032 49 STATE STREET
MARION NC 28752 CHECK NUMBER: 180388
CHECK DATE: 12/16/2009
DEPARTMENT ACCOUN PO NUMBER INV OICE NUMBER A MOUNT D ESCRIPTION
2200 4355300 100.00 ORGANIZATION MEMBER
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CPESC Re ewal Not" A: m �ll�®
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2009 2 0 O A NOSED \M���
JOHN G'HARRITYTHOMAS Amount Due
.$100_00
11576: CREEK SIDELANE'
Date 7 Duel December 3t, 2009
CARMEL,I;N 46033.: RETURN ;THIS.FORMWITHYf�URPAYMENT
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Renewal Fee Details:
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Founding Discount
Individual,membershi in l ECA or SWCS qualifies registrants for discounted renewal fees. Eligibility'for the discount is
based on Individual membership- ONLY!- Use of corporate membership by other•than the corporate merh6ermay result
in'loss.of certification: Membership will be.verified. :This discount is lo'b`e dlscontinued•effeic September 1; 2010.
j To receive the Founding Partner Discount; enter youir membership, numbers) *below
ECA Memb`ers`hip SWCS Membership
i
Professional Development Affirmation•
CPESC ...Current Period ,i /1 /2009`, .12131 .:Requirement. 6o PDUs per 3 Year Period'- Minimum of z Categories
Revlew:your training;records and select either YES or NO In:response%to the followingstatement:
I HAVE COMPLETED.` PROFESSIONAL DEVEL OPMENT REQUIREMENTS FOR THE CURRENT PERIOD ❑YES NO
Y Sign and a space bel (See backp for explanatlon.).
John charrity Thomas "'Date
Information UPC�ate •,(Please:mark this notice with any changes fo your contact_information
Business Phone: (317).75b-12, 9, Ext. Fax: (317)'57,1,2439 Home Phone: (3 11 7)' 811 5 1111 96
Email: ithomas carmel.in.gov.
Please-list any professional titles that ou currently hold for exam le PE RLA)
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Payment Information x
ENTER YOUR'PAYMENTINFORMATION ON THE REVERSE SIDE'OF THIS NOTICE.
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I 49,STATE STREET MARION N C 287 PHONE: 828.655.1600 FAX: 828.655:1622 WWWZPESC:ORG
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I AN ENVIROCERTINTEHNATIONAL, INC. PROGRAM
John Gharrity Thomas CPESC
1157:6 Creek Side Lane
Caramel IN 60.
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Payment Inforrn ation'(Please write legibly)
RETURN THIS SHEET WITH YOUR PAYMENT. 1
Payment aiilount DD (in'US dollars)
i_ Payment method.,. Cash te]�Check /Money Orden Visa 0 Diners Club MasterCard
Make check- payabl to'CPESC, Inc in US funds
he 1. j.,
Creclit Card'Number
Expiraii6n "bate:
i. Name of'Ca"rd:Holder
Signature'of Card Holder
Address of Card Holder'
IMPORTANT! Chec reverse side.of this form to en that the Professional. Development
Affirmation section has been- signedlanddated.
Professional 'Development,Affithiatlor Explanation
Professional:development is a fundamental of the CPESC program Td-completearenewal, 'you
must sign affirmation statement (on the reverse side of this ,notice) regarding your compliance with
p' p q ents. Failure to renew your certification by paying the renewal fee AND
rofessional develo merit re uirem
signing the statement is a basis for suspension of your ce.itification
Checking YES means that you have'completecl the'PDU`requirements. the current period.` We will advance
vnnr Pill l�pprlOC� tn,tha' next throe sar, block an isciin
Checking NO means that you .have NOT completed th&requirements for the current PDU period Your CPESC
r certification will remain Active and anew ID card will be issued'. However,•.vve NOT'advance your PDU`
period -to the next-three- .year block
I If you need assistance in determining whether you have met.the PDU requirements,'please`contact our office, `7
as shown on the reverse side of this notice. Remember, it i a violation the Code of Ethics to`knowingly''
provide false information to the CPESC Administrative Office. (See CPESC Certification Procedures and
Standards, Article h, Section 4, Item B.z for details)
2.
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
ayee
Purchase Order No.
49 State Street
Terms
Marion, NC 28752
Mte Due
t;
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
n/a CPESC #366 1- Yr Certification renewal -John Thomas $100.00
ii
Total $100.00
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.
"CPESC
ALLOWED 20
49 State Street IN SUM OF
Marion, NC 28752
$100.00
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
n/a CPESC #3668 12b0 -'E 3b $100.00 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
2 20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund