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Home My WebLink About180464 12/16/2009 �f CITY OF CARMEL, INDIANA VENDOR: 363105 Page 1 of 1 ONE CIVIC SQUARE INTL POLICE MOUNTAIN BIKE ASSOC CHECK AMOUNT: $250.00 CARMEL, INDIANA 46032 583 FREDERICK ROAD SUITE 5B o� BALTIMORE MD 21228 CHECK NUMBER: 180464 CHECK DATE: 12/16/2009 D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4357004 21224 250.00 EXTERNAL INSTRUCT FEE International Police Mountain Bike Association Invoice 583 Frederick Rd. Ste 5B 'Baltimore, MD 21228 DATE INVOICE 410-744-2400/Fax: 410-744-5504 12/2/2009 21224 BILL TO SHIP TO Carmel Police Dept. Attn: Teresa Anderson 3 Civic Square Carmel, IN 46032 DUE DATE P.O. NUMBER FED TAX ID 52- 2137781 12/17/2009 21254 QUANTITY DESCRIPTION PRICE EACH AMOUNT 2 Instructor Application Fee (Schoeff. Pitman) 125.00 250.00 Please enclose a copy of this invoice with payment and include invoice Total number on all correspondence. $2so.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. o�Co`ice Nloun f ai44 r 'e POLICE i ON BIDES m e IPMBA A a o Please complete this application fully and accurately. You may attach additional pages as necessary. In order for your application to be processed, your application packet must contain each of the items specified on the IPMBA Instructor Application Checklist. Applications lacking any of the required items will be returned and /or subject to processing delays. Name: D0 4OLD D Srwo EFf .SR H e you included Home Address: .1.1 Q^10502 SCUV IVE our typed or printed application form City, State, ZI F151ya s, :z'j U(A photocopy of your IPMBA- issued Basic Cyclist Certificate OR... Home Phone: 7 435 It U33 Completed Membership Certification Application Form and $10 fee* (if you are not already a certified member) Email: dscAo 1W 6 Carr•e �.1`n Qov! 5 Letter of Recommendation and support from your Department Name: department completed Instructor Recommendation form Department Address: 3 C.GVIe EWAA- Additional documentation to support your application (optional) City, State, ZIP: 0,41"r L T^J (100 9A Your $125 application fee` Your $50 membership dues' (d you are not a Dept. Phone: _'317- .S7i- 4 =0 member or if vour membership has expired) Dept. Fax: 2 17 5 7 1 -)S /o2 `Fees are non- refundable Check o what applies to ou! Payment Information 1. 1 am aV a current IPMBA Member (member 0 1 5 d71o/ $125 IPMBA Instructor Application Fee` joining IPMBA (my $50 dues are enclosed) Li renewing IPMBA (my $50 dues are enclosed) L3 $50 Membership Dues* (for new 8 renewing members) 2. 1 am ran IPMBA Certified Police, EMS, or Security Cyclist $10 Basic Cyclist Certification Fee" (if applicable) not IPMBA- Certified yet, but my Police /EMS /Security Cyclist certification application and $10 fee Total Enclosed are enclosed. Check MCNisa awaiting my certificate. I submitted I_ I_ I_ I_ I_ I_ I_ I_ I_ I_ I_ I_ I_ I_ I_I_I Membership and Certification Application on 3. 1 am L2(a member of a police bike unit Exp: a member of an EMS bike unit a member of an Security bike unit I have answered all of the questions on the attached questionnaire as accurately as possible. 1 have read and am able to demonstrate extensive knowledge of The Complete Guide to Public Safety Cycling. I scored at least a 90% on my PC /EMSC /SC written test. I am a P.O.S.T. (or equival t) licensed law enforcement officer, or an active firefighter, EMT or paramedic, or am employed as a security officer by a a curity „provider. Signatur Date: Please mail to: IPMBA Instructor Application 583 Frederick Rd., Suite 513 Baltimore MD 21228 Questions? Call 410 -744 -2400 or e-mail info @ipmba.org 02008 International Police Mountain Bike Anociation. Revised June 2009. Page 6 of 14 r c °`Qo POLICE' 7Mo i ON BIKES n u IPMBA Please complete this application fully and accurately. You may attach additional pages as necessary. In order for your application to be processed, your application packet must contain each of the items. specified on the IPMBA Instructor Application Checklist. Applicatio lacking any of the required items will be returned and /or subject to processing delays. Name: M I As Y 1 P,d Home Address: C- t,4L vat C, Have you included El Your typed or printed application form City, State ZIP: �:OYAF- J d3Z A photocopy of your IPMBA- issued Basic Cyclist Certificate OR... Home Phone: Completed Membership Certification Application Form and $10 fee' (if you are not already a certified Email: MQI]2 84 CARm£ 1N, 4o4 member) Letter of Recommendation and support from your Department Name: L:1 D: 191 iGE department �t D Completed Instructor Recommendation form Department Address: J� 2E Additional documentation to support your application (optional) City, State ZIP: �CI�M��T f �1Y Z Your $125 application fee' 1 w z 6DD 13 Your or i membership dues' you are not a De pt. Phone: member or f your membership has exDiredl Dept. Fax: �3 Z S 7-3 'Fees are non refundable Check o what applies to you! Payment Information 1. 1 am Y a current IPMBA Member (member o :3 joining IPMBA (my $50 dues are enclosed) l�'$925 IPMBA Instructor Application Fee* o renewing IPMBA (my $50 dues are enclosed) $50 Membership Dues" (for new& renewing members) 2. 1 am Ilan IPMBA Certified Police, EMS, or Security Cyclist $10 Basic Cyclist Certification Fee' (if applicable) not IPMBA Certified yet, but my Police /EMS /Security Cyclist certification application and $10 fee Total Enclosed are enclosed. Check MCNisa awaiting my certificate. I submitted I_ I_ I_ I_ I_I_I_I_I_I_I_I�I_I_I_I_I Membership and Certification Application on 3. 1 am lea member of a police bike unit Exp: a member of an EMS bike unit a member of an Security bike unit I have answered all of the questions on the attached questionnaire as accurately as possible. I have read and am able to demonstrate extensive knowledge of The Complete G 'de to Public Safety Cycling. I scored at least a 90% on my PC /EMSC /SC written test. I am a P.O.S.T. (or equivalent) licens enforcement officer, or an active firefighter, EMT or paramedic, or am employed as a security officer by a proprietary o ider. Signature Date: ell Please mail to: IPMBA Instructor Application 583 Frederick Rd., Suite 5B Baltimore MD 21228 Questions? Call 410 744 -2400 or e-mail info @ipmba.org C2008 International Police Mountain Bike Association. Revised June 2009. Page 6 of 14 Presc� bed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 7995) 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 International. Police MOuntdin Bike Assoc. Purchase Order No. 583 Frederick Road, Suite 5B Terms Baltimore, MD 21228 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 1212/09 21224 paym ent for International Police Mountain Bike 250.00 Tnstructor school for Offic c oe f and Ddf. Mike Finhan on May I 8, 20 10 in St. Louis, MO 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 I nternational Police Mountain Bike Ass IN SUM OF 583 Frederick Road, Suite 5B Baltimore, MD 21228 250-00 ON ACCOUNT OF APPROPRIATION FOR p olice general fund Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 7�� 91224 570-04 250.00 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 December 8 20 Og -b Signature Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund