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Home My WebLink About205902 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 363105 Page 1 of 1 ONE CIVIC SQUARE INTL POLICE MOUNTAIN BIKE ASSOC CHECK AMOUNT: $525.00 CARMEL, INDIANA 46032 583 FREDERICK ROAD SUITE 5B BALTIMORE MD 21228 CHECK NUMBER: 205902 CHECK DATE: 1/31/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 210 4357000 25962 21410 525.00 TRAINING International Police Mountain Bike Association Invoice 583 Frederick Rd. Ste 5B Baltimore, MD 21228 DATE INVOICE 410-744-2400/Fax: 410-744-5504 111212012 21410 BILL TO SHIP TO Carmel Police Dept. Attn: Accounts Payable 3 Civic Square Carmel. IN 46032 VENDOR: 363105 Page 1 of 1 CITY OF CARMEL, INDIANA INTL POLICE MOUNTAIN BIKE ASSOC CHECK AMOUNT: $525.00 ONE CIVIC SQUARE 583 FREDERICK ROAD SUITE 5B CHECK NUMBER: 205902 CARMEL, INDIANA 46032 BALTIMORE MD 21228 CHECK DATE: 1131/2012 AMO UNT DESCRIPTION DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER 525.00 TRAINING 210 4357000 25962 21410 Please enclose a copy of this invoice with payment and include invoice Total number on all correspondence. $s2s.00 The International Police Mountain Bike Association is a non -profit organization dedicated to providing training and resources to police and EMS personnel on bikes. 22 r f nd Annual IPMBA Co nference St. Paul, Minnesota April 28 -May 5, 2012 Registration Form Page 1 of 2 P lease read "Registration Checklist" on back of workshop descriptions before filling out this lease check all boxes that apply and add registration form. PRINT LEGIBLY. up the right column for your total. You To avoid rush fee, registration forms must be received by March 24 2012. can register for just the pre- conference, just Name (As you would like it to appear on your namelag, and in all correspondence) the conference, or, ideally, both! You ®o�oaoo ❑goo ®ao must be a current member to attend any of the preconference First Last training courses. Join or renew below if you are not currently a member. Home Address Bicycle Response Team Trainin J D Q► S G-�itT g Li $375 EMS Cyclist Course $325 Street Address (Ae 'C y IPMBA Instructor Course $550 city State o p ostal code Country IPMBA Instructor Application enclosed I...... $12 '1� L� O Home Personal Telephon �A r° y� J p IH II You must apply and be approved to attend. Contact the IPMBA office with questions. e I Maintenance Officer Certification Course ....01($525 E -Mail f�n4r4 /d &,m� jI�[ p MMR -IPMBA Core Skills 6 Scenarios Clinic. $495 (co vmations 'll be soot via il. TM will NOT b el .J r ema nn am Dept. Name f}� M E� Ye IiGE- Police Cyclist Course $325 3 JAs will appear on n` efegf C C w Dept. Address Street Address V IPMBA Member Fee $400 C ARMd r� MUST be current; you must provide your current IPMBA membership 777 0 number on this form or joinirenew with this registration. city State Postal Code Country Non IPMBA Member Fee Telephon 574 $475 Dept. T Fee for Pre- Conference Attendees $350 If you IPMBA Membership Number q p are attending of the also attend ng courses, this is the tee you pay to also allentl the conference. (Mo afory for current anal renewing members.) Bike Team Rate Instructor Number CT i $350 See box in left column for details. Tee Shirt Size ❑M ❑L ❑XXL ❑XXXL (You will receive a LARGE if you don't check a size!) Guest Fee (per guest) Guests x $50 The guest fee entitles your guest admission to the exhibit hall and two lunches. NAME(s): Lunches are included in the cost of each pre- conference course. During the conference, lunches will be served on Thursday nd Frid Rush Fee nssu su 201., mus incl rush 25 y y; please check the RegistraUOnssubmitted after March 24, 2012, must include the rush fee. appropriate boxes on the reverse. All other meals are on your own. Exhibit Hall -Only Pass (Pre Registration Required) Free Register three or more members from the same agency at a flat rate of New Renew 50 $350 per team member! The following conditions apply: Applies to CONFERENCE fees only. Does NOT apply to Pre- Conference Course Fees. TOTAL ENCLOSED Can be used by both conference only attendees and those attending both a CANCELLATION POLICY: Refund requests must be made in writing and postmarked by pre conference course and the conference. March 24 2012. Refunds, less a $50 adnunistration lee, will be processed following the conference. No refunds after March 24. If you must cancel after March 24, you may locate a Registrants MUST be IPMBA members (current, joining or renewing). substitute and submil hisrherregistration form and a letter requesting the transfer of fees. Registrations MUST be submitted together (offer not available online). Membership, certification, and instructor application fees are non- refundable. IF YOU ARE REGISTERING FOR THE CONFERENCE, HAVE YOU COMPLETED PAGE 2 OF THIS FORM? Form of Payment [MUST ACCOMPANY REGISTRATION] Purchase Order number Check or money order (payable to IPMBA) enclosed. or departmental equivalent: Visa /MasterCard accepted (circle one). I I I I I I I— I— I— I— I— I— I —I —I —I Department to which the invoice should be sent Expire: Signature: Attention Name on card: Address Email address for receipt: Contact phone: City Slate ZIP Phone Police on Hikes. Inc. dba International Police Mountain Hike Assuciation'.c l ederal I.D. Number: 51 1137781 W12 f� INDIANA RETAIL TAX EXEMPT PAGE Cit o li Y Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 26M 35- 60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. 'URCHASE ORDER DATE ..DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION V10=12 IPNBA Carmel Police Dewtmont VENDOR SHIP 3 CIVIC squm 5M Frederick Road, Suite 5B TO Carmel, IN 45032 Baltimore, W 29223 (397) 579 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 1 Each training $525.00 $525.00 Sub T $525.00 t%j�' 22nd Annual IPMBA Can �Porl ovN�a srn ail 28 M@y 5, 2012 In St. Paul, MN Send Invoice To: -�Y� Carmel Police DOpartment Attn: Teresa Andorson 3 Civic Square Carmel, IN PLEASE INVOICE IN DUPLICATE DEPARTMENT ,ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Carmel Police Depot. c $5 PAYMENT A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY WT TAERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRI�Ft0 S ?FICIENT TO PAY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. Police THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Y' AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK TREASURER DOCUMENT CONTROL NO. 2 5 9 6 2 A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO. WARRANT ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I 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 20 Signature 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)) 01/12/12 21410 training $525.00 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. ALLOWED 20 IPMBA R4eM( I y6LA am, A4 -4., IN SUM OF 583 Frederick Road, Suite 5B �C Baltimore, MD 21228 $525.00 ON ACCOUNT OF APPROPRIATION FOR CPD Continuing Ed Fund PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 25962 I 21410 I 570.00 I $525.00 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, Ja uary 27, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund