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Home My WebLink About174950 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 363105 Page 1 of 1 ONE CIVIC SQUARE INTL POLICE MOUNTAIN BIKE ASSOC t CARMEL, INDIANA 46032 CHECK AMOUNT: $120.00 583 FREDERICK ROAD SUITE 5B BALTIMORE MD 21228 CHECK NUMBER: 174950 CHECK DATE: 7/22/2009 DE PARTMENT ACCOUNT PO NUMBER INV NUMBER A DESCRIPTION 1110 4355300 120.00,ORGANIZATION MEMBER IPMBA MEMBERSHIP AND CERTIFICATION APPLICATION BENEFITS: Internationally recognized IPMBA Police, EMS or Security Cyclist Certificate... IPMBA News (training tips, product reviews, funding information, and resources) FREE subscription to Bicycling* Magazine... Discounted registration to IPMBA's Annual Conference... Access to advanced training opportunities, including the IPMBA Instructor Course... Members -only discounts on equipment and gear... IPMBA member decals! *U.S. and Canadian addresses only. IPMBA certification is available to members only. Name ,SCUD Ff Police EMS Security IPMBA membership is open to Home Address faQQ W I00.5 Soup! L/r individuals only. City FLSL)EU State( Zip /Country �A®D3r Membership materials will be Home Phone (,3/') N3g_(Q(0 Mobile (3/7 !0 7 9St7� mailed to your home address. (Allow 6r8 weeks) E -Mail Address d- rcAvP�fYd .Q G,; gal/ Department 12A&rnrL Auer Please mail applications and payment immediately following Department Address 3 C I V 11' Sw U O?— the course. City ('AIZ ►'MFC State- Zip /Country V&O-?k Dept. Phone (217 5 71 AEVA) Dept. Fax Membership Number (for current IPMBA members) Mail form to: I have taken the minimum 32 -hour el Police EMS Cyclist Course, or the IPMBA minimum 24 -hour Security Cyclist Course and passed (minimum 76 the 583 Frederick Rd. Police, EMS, or Security Cyclist Written and On -Bike Examinations. Suite 513 Baltimore MD Primary IPMBA Instructor's Name: A L Sip,�l 21228 Instructor Number: _112.57 or- Dates of the Course: Month t./p(E Dates I Year d609 Location of Course: L rmr i 0, c4go -1 'L, Fax credit card info to: (Facility Name, City, and State) 410 744 -5504 1 would like to become an IPMBA- Certified PAYMENT METHOD (U.S. FUNDS ONLY) Police, EMS, or Security Cyclist and join X check or money order is enclosed (payable to IPMBA) IPMBA's Registry of Certified Public Safety Please charge my: Visa /MasterCard (Circle One) Cyclists. Name on Credit Card (please print): (Certification is only available to current, renewing, or joining members.) Email Address of Card Holder: Y sm.00 IPMBA Membership Fee Credit Card Number: 10.00 Certification Fee (Membership required for Certification) Expiration: Code: Billing Address: Home El Department L1 5.00 Police Cyclist Pin gold or silver) Signature: 5.00 EMS Cyclist Pin (gold only) Purchase orders accepted for multiple memberships only. 5.00 Security Cyclist Pin (silver only) Federal Tax ID: 52- 2137781 $Q0. 00 TOTAL 2009 International Police Mountain Bike Association e www.ipmba.org Reset Form Submit Form IPMBA MEMBERSHIP AND CERTIFICATION APPLICATION BENEFITS: Internationally recognized IPMBA Police, EMS or Security Cyclist Certificate... IPMBA News (training tips, product reviews, funding information, and resources) FREE subscription to Bicycling* Magazine... Discounted registration to IPMBA's Annual Conference... Access to advanced training opportunities, including the IPMBA Instructor Course... Members -only discounts on equipment and gear... IPMBA member decals! *U.S. and Canadian addresses only. IPMBA certification is available to members only. Or Name i Police EMS Security O IPMBA membership is open to Home Address .%lt/ individuals only. City State. Zip /Country �8 Membership materials will be Home Phone 31 Mobile mailed to your home address. E -Mail Address t s (Allow 6 -8 weeks) Department 1`C V Please mail applications and Department ddress payment immediately following the course. City State Zip /Country Z Dept. Phone 31 �l 7 �b Dept. Fax I 3 Membership Number (for current IPMBA members) Mail forth to: I have taken the minimum 32 -hour ii�Police EMS Cyclist C�_;:,;e, or the IPMBA minimum 24 -hour O Security Cyclist Course a -:1'-, ssed (minimum 76 the 583 Frederick Rd. Police, EMS, or Security Cyclist Written, and On -Bike Examinations. Suite 5B Primary IPMBA Instructor's Narr.c. Baltimore MD Inst ructor Nummber:_ 21228 Dates of the Course: Mon JL Dates Year -or- Location of Course: tt S Fax credit card info to: (Facility Name, City, and State) 410- 744 -5504 [I would like to become an IPMBA- Certified PAYMENT METHOD (U.S. FUNDS ONLY) olice, EMS, or Security Cyclist and join My check or money order is enclosed (payable to IPMBA) Registry of Certified Public Safety Please charge my: Visa /MasterCard (Circle One) yclists. Name on Credit Card (please print): (Certification is only available to current, renewing, or joining members.) Email Address of Card Holder: 8 $50.00 IPMBA Membership Fee Credit Card Number: $10.00 Certification Fee (Membership required for Certification) Expiration: Code: 5.00 Police Cyclist Pin gold Billing Address: Home Department or silver) 5.00 EMS Cyclist Pin (gold only gnature: Purchase orders accepted for .0� Security Cyclist Pin (silver only) multiple memberships only. 0 0 TOTAL Federal Tax ID: 52- 2137781 0 2009 International Police Mountain Bike Association www.ipmba.org Reset Form Submit Form INVOICE Date: July 15, 2009 Sold to: City of Carmel Police Department 3 Civic Square Carmel, IN 46032 IPMBA membership dues for Det. Mike Pitman and Officer DJ $120.00 Schoeff Please make check payable to: IPMBA 583 Frederick Road, Suite 5B Baltimore, MD 21228 IPMBA MEMBERSHIP AND CERTIFICATION APPLICATION BENEFITS: Internationally recognized IPMBA Police, EMS or Security Cyclist Certificate... IPMBA News (training tips, product reviews, funding information, and resources) FREE subscription to Bicycling* Magazine... Discounted registration to IPMBA's Annual Conference... Access to advanced training opportunities, including the IPMBA Instructor Course... Members -only discounts on equipment and gear... IPMBA member decals! *U.S. and Canadian addresses only. IPMBA certification is available to members only. Name SC j -10EFf Police EMS Security IPMBA membership is open to Home Address I I b,9 50 u7}l Daiyc individuals only. City F t s wers State Zip /Country Y0078 Membership materials will be mailed to your home address. Home Phone (,3/'7 y39= CQ1p33 Mobile (3/7 &17 95-OA (Allow 6-8 weeks) E -Mail Address GI�ScAoeA arinp /'j yl g�pt/ Department t-.L R1nrL AUCC Please mail applications and payment immediately following Department Address J d) V I C ..S(; uA2.1` the course. City 6AX -7Et State Zip /Country V&02k Dept. Phone (,717 .57/'a?_f'CV Dept. Fax Membership Number (for current IPM BA members) Mail form to: I have taken the minimum 32 -hour YPolice EMS Cyclist Course, or the IPMBA minimum 24 -hour Security Cyclist Course and passed (minimum 76 the 583 Frederick Rd. Police, EMS, or Security Cyclist Written and On -Bike Examinations. Suite 5B Baltimore MD Primary IPMBA Instructor's Name: AL fi m all/ 21228 Instructor Number: /19ST -or- Dates of the Course: Month 1u4E Dates /1�,�� I Year p?{2cJ� Location of Course: 1A� Af r_ P T A Fax credit card info to: (Facility Name, City, and State) 410- 744 -5504 I would like to become an IPMBA Certified PAYMENT METHOD (U.S. FUNDS ONLY) Police, EMS, or Security Cyclist and join Xy check or money order is enclosed (payable to IPMBA) IPMBA's Registry of Certified Public Safety Please charge my: Visa /MasterCard (Circle One) Cycl ists. Name on Credit Card (please print): (Certification is only available to current, renewing, Z50.0 .ining members.) Email Address of Card Holder: IPMBA Membership Fee Credit Card Number: Certification Fee (Membership required for Certification) Expiration: Code: Billing Address: Home CJ Department 5.00 Police Cyclist Pin (C) gold or silver) Signature: 5.00 EMS Cyclist Pin (gold only) Purchase orders accepted for multiple memberships only. 5.00 Security Cyclist Pin (silver only) Federal Tax ID: 52- 2137781 $f 00 TOTAL 2009 International Police Mountain Bike Association www.ipmba.org Reset Form J'^ Submlf "Forms IPMBA MEMBERSHIP AND CERTIFICATION APPLICATION BENEFITS: Internationally recognized IPMBA Police, EMS or Security Cyclist Certificate... IPMBA News (training tips, product reviews, funding information, and resources) FREE subscription to Bicycling* Magazine... Discounted registration to IPMBA's Annual Conference... Access to advanced training opportunities, including the IPMBA Instructor Course... Members -only discounts on equipment and gear... IPMBA member decals! *U.S. and Canadian addresses only. IPMBA certification is available to members only. Name 1 �`771s Police EMS Security IPMBA membership is open to Home Address individuals only. �/1� 'p Membership materials will be City LX State Zip /Country y��f04' Mobile mailed to your home address. Home Phone t (Allow 6-8 weeks) E -Mail Address V Department l Please mail applications and payment immediately following Department ddress the course. City State Zip /Country Z Dept. Phone 3 J 7 i' 2.5 Dept. Fax (31T) 1 Membership Number (for current IP MBA members) Mail form to: I have taken the minimum 32- hour id Police EMS Cyclist Course, or the IPMBA minimum 24 -hour Security Cyclist Course and passed (minimum 76 the 583 Frederick Rd. Police, EMS, or Security Cyclist Written and On -Bike Examinations. uite 5B �s. Baltimore MD Primary IPMBA Instructor's Name: E J 21228 Instructor Number: r -or- Dates of the Course: Mo Dates Year Location of Course: I° t x a Fax credit card info to: (Facility Name, City, and State) 410 744 -5504 1 would like to become an IPMBA- Certified PAYMENT METHOD (U.S. FUNDS ONLY) Police, EMS, or Security Cyclist and join U ZMy check or money order is enclosed (payable to IPMBA) IPMBA's Registry of Certified Public Safety Please charge my: Visa /MasterCard (Circle One) Cycl ists. Name on Credit Card (please print): (Certification is only available to current, renewing, or joining members.) Email Address of Card Holder: 0" $50.00 IPMBA Membership Fee Credit Card Number: $10.00 Certification Fee (Membership required for Certification) Expiration: Code: 5.00 Police Cyclist Pin gold Billing Address: Home Department or silver) Signature: 5.00 EMS Cyclist Pin (gold only) Purchase orders accepted for 5.00 Security Cyclist Pin (silver only) multiple memberships only. Federal Tax [D: 52- 2137781 TOTAL 2009 International Police Mountain Bike Association www.ipmba.org Reset Form j Submit Form 4 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 IPMBA Purchase Order No. 583 Frederick Rd., Suite 5B Terms Baltimore, MD 21228 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 7/15/09 payment for membership dues for Officer DJ Schoeff 60.00 7/15/09 payment for membership dues for Officer Mike Pitman 60.00 Total 120.00 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. 1 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 T PM'3A IN SUM OF 583 Frederick Rd., Suite 5B Baltimore, MD 21228 120.00 ON ACCOUNT OF APPROPRIATION FOR police general fund Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1110 553 60.00 bill(s) is (are) true and correct and that the 1110 553 60.00 materials or services itemized thereon for which charge is made were ordered and received except July 15 2009 Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund