176781 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 361689 Page 1 of 1
ONE CIVIC SQUARE HOLIDAY INN EXPRESS
CARMEL, INDIANA 46032 107 BUFFALO CREEK DRIVE CHECK AMOUNT: $1,091.50
ELIZABETHTOWN KY 42701
CHECK NUMBER: 176781
CHECK DATE: 9/2/2009
DEPARTMENT ACCOUNT PO NUM BER INV OICE N A MOUNT DE SCRIPTION
210 4357000 1,091.50 TRAINING SEMINARS
e
INVOICE
Date: August 25, 2009
Sold to: City of Carmel Police Department
3 Civic Square
Carmel, IN 46032
Payment for lodging for Wendy Bodenhorn on September 14 25, 2009 in
Elizabethtown, KY
Confirmation #375630 Sept 13 —18
Confirmation #375631— Sept 20 25
Room Rate Tax Total
$99.00 $10.15 $109.15 x 10 $1,091.50
TOTAL DUE: $1,091.50
Please make check payable to:
Holiday Inn Express
107 Buffalo Creek Drive
Elizabethtown, KY 42701
luiNTUCKY STA'L'E POLIC
APPLICATION FOR D.A.R.E. OFFICER TRAINING
PARTICIPANT PLEASE PRINT OR TYPE
Last Name OT In First I Middle
In case of emergency contact Telephone 7Co6
Do you have any significant health problems? 0 V
Your name as you wish it to appear on our: Name tent th Certificate
LAW ENFORCEMENT EXPERIENCE Please read and carifully answer each question
I am a swom police officer with full enforcement authority: Yes No
Number of years of full time street experience as a sworn officer:
I am assigned or have had assignments to: School Resource fficer Uniform/Patrol F Juvenile
Community/Public Relations Investigations Narcotics
CERTIFICATION Please read and carefully answer each question) YES NO
I understand that D.A.R.E. is an assignment which requires wearing a uniform:
I understand and agree to be monitored by the State Police after certification for guideline compliance:
A school has agreed to use me as their D.A.R.E. Officer:
I am able to completely devote my time and energies to this training:
My calendar is cleared of any and all obligations for the duration of this training:
TO BE COMPLETED BY AGENCY HEAD YES NO
Our agency intends to use the officer /applicant during the next school year.
The applicant/officer will be used: Full Time Part Time Relief/Substitute
Has the applicant had any disciplinary actions against him/her within the past 3 years
The applicant/officer will be given sufficient time to properly deliver D.A.R.E.
I understand that the D.A.R.E. Officer is required to teach in uniform and will be periodically monitored
by the State Police for guideline compliance.
I understand that D.A.R.E. officer Training is a comprehensive program that will demand the undivided
attention of the applicant/officer, and I am aware that attendance at all classroom sessions is mandatory:
I understand that the applicant/officer must successfully demonstrate the knowledge, attitudes and skills
necessary to effectively deliver the D.A.R.E. curriculum in order to be certified and after certification
may be decertified for cause:
APPLICANT SURVEY
I am attending the D.A.R.E. Officer Training seminar because:
0 I have requested to attend. I have been ordered to attend.
I am to evaluate the potential use of this program for my agency. I am not certain.
My knowledge of D.A.R.E.: Very little Some knowledge Good understanding
How many schools /classes will you be teaching during the next semester? Schools Classes I LI
Please describe how you were selected for this training. (appointment pe the se ection process JJ
Why do you want to be a D.A.R.E. Officer? a,� 40 7
What do you hope to receive during this training?
Have you ever attended or been refused admission to any prior D.A.R.E. Officer Training Class? Yes No
If yes, please explain in detail. (Date, location, training agency, etc.)
AUTHORIZATION
Participant's Signature: Date:
Agency Head's Si nature: Date: Q 0
Forward this application and application fee to: Kentucky State olice DARE Unit, 919 Versailles Road, Frankfort, KY 40601
Application fee: In -State $100.00 Out of State $250.00
Revised 05/22/08
CAKMEL POLICE DEPARTMENT
APPLICATION FOR SPECIALIZED TRAINING
Today's Date: 08/10/2009 Employee: 2352 W4, mi✓N a>Z tj
Name of School: DARE U
Cost: unknown
i
Location of School: Elizabeth Town
State: KY
Topic Subject Matter: DARE officer training
Dates of School: From: 09/14/2009 To: 09/25/2009
Contact Person: Bruce Olin
Telephone Number: (502) 695 -6343
How will this School benefit You and the Department? I will be certified to teach inside
the schools.
Will you need C.P.D. Transportation? ®Yes ❑No
Will you need accommodation? ®Yes ❑No
"OVERTIME COMPENSATION WILL NOT BE PAID IF YOU VOLUNTEER
TO ATTEND A SCHOOL, ONLY IF YOU ARE ORDERED TO ATTEND.
Officer's Signature:
Supervisor' Signature: D��, Date: 6
All r
Division Commande Date:
Training Officer: Date:
*OFFICE USE ONLY BE THIS LINE*
Presc,'bed 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
Holiday Inn Express Purchase Order No.
107 Buffalo Creek Drive Terms
Elizabethtown, KY 42701 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
8/25/09 payment for lodging for Officer Wendy Bodenhorn while 1,091.50
attending DARE Officer training on September 14 25,
2009 in Elizabethtown, KY
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.
ALLOWED 20
Holiday Inn Express IN SUM OF
107 Buffalo Creek Drive
Elizabethtown, KY 42701
1,091.50
ON ACCOUNT OF APPROPRIATION FOR
cont ed.fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
210 570 1,091 .50 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
August 25 20 09
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund