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Home My WebLink About206284 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 00353282 Page 1 of 1 ONE CIVIC SQUARE INDIANA ASSOC OF CITY ENGINEERS CARMEL, INDIANA 46032 ATTN: CHERYL MENCSIK CHECK AMOUNT: $80.00 PO BOX 273 CHECK NUMBER: 206284 ON LAGRANGE IN 46761 CHECK DATE: 2/14/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2200 4355300 80.00 ORGANIZATION MEMBER MEMBERSHIP APPLICATION AND INVOICE For calendar year 2012 INDIANA ASSOCIATION OF CITY ENGINEERS (LACE) Please type or print: Individual Name: M C, l -�V 1 11 Cv�ac 7 Last First M. 1. Mailing Address: V _\f�C Number Street City or Town State Zip E -Mail Address: y1IAN QD l -de, e C L -VyV -a T Position or Title: EVnQ t V\,Q City /Town/Company /Organization: C Telephone: Fax: Area Code Number Area Code Number Membership Classes (Please check appropriate class and remit dues for that class): REGULAR MEMBER Any individual serving full time as a city or town engineer, or ruing as supervisor or director of a municipal engineering department. Regular members may vote, serve on committees and hold office. Annual dues are $30.00. AFFILIATE MEMBER Employees in municipal engineering departments, Public Works Directors, Town Managers, etc. or representatives of IACT, Indiana LTAP, INDOT, FHWA, etc., with an unbiased and sincere interest in the Association. Note that the dues may be waived for qualifying affiliate members with approval of the Executive Board. Affiliate members may serve on committees but may not vote or hold office. Annual dues are $20.00. ASSOCIATE MEMBER Vendors, consultants or other "friends" of the Association. Associate members may participate in meetings but may not vote, serve on committees or hold office. Annual dues are $125.00. Make checks payable to: "LACE" and mail with this form to Cheryl Mencsik, Executive Secretary, [ACE, P.O. Box 273, LaGrange, IN 46761. Our Federal EIN is 35- 2132826. Please reproduce form for applications for your employees, associates, etc. MEMBERSHIP APPLICATION AND INVOICE For calendar year 2012 INDIANA ASSOCIATION OF CITY ENGINEERS (IACE) Please type or print: Individual Name: 'buts QAN J Last First Q� M.I. f Mailing- Address: �d3� Q�� t ELL CWII� 4 �'�t S 4q M Number Street City or Town State Zip E -Mail Address: Q (tlNlCfkyl CG ~�Me 1Vl Q V V Position or Title: kS I S T!N t Ct n L7'u�rlV L-'t= City/ Town /Company /Organization: jl j O F Cd( 7 Telephone: 3 i 7 5 7 1 24 fax: 317 6 7 1 Area Code Number Area Code Number Membership Classes (Please check appropriate class and remit dues for that class): REGULAR MEMBER Any individual serving full time as a city or town engineer, or serving as supervisor or director of a municipal engineering department. Regular members may vote, serve on committees and hold office. Annual dues are $30.00. AFFILIATE MEMBER Employees in municipal engineering departments, Public Works Directors, Town Managers, etc. or representatives of IACT, Indiana LTAP, INDOT, FHWA, etc., with an unbiased and sincere interest in the Association. Note that the dues may be waived for qualifying affiliate members with approval of the Executive Board. Affiliate members may serve on committees but may not vote or hold office. Annual dues are $20.00. ASSOCIATE MEMBER Vendors, consultants or other "friends" of the Association. Associate members may participate in meetings but may not vote, serve on committees or hold office. Annual dues are $125.00. Make checks payable to: "IACE" and mail with this form to Cheryl Menesik, Executive Secretary, IACE, P.O. Box 273, LaGrange, IN 46761. Our Federal EIN is 35- 2132826. Please reproduce form for applications for your employees, associates, etc. MEMBERSHIP APPLICA'T'ION AND INVOICE For calendar year 2012 INDIANA ASSOCIA'T'ION OF CITY ENGINEERS (IACE) Please type or print: Individual Name: ro I e Last First M.I. Mailing F1dress:____ Number Street City or Town State Zip E -Mail Address: e_ Q L i 14 Position or Title: Q, n l City /Town /Company /Organization: �j of Telephone: ?3 6 Fax: 17 r 51 -5 Area Code Number Area Code Number Membership Classes (Please check appropriate class and remit dues for that class): 4 REGULAR MEMBER Any individual serving full time as a city or town engineer, or serving as supervisor or director of a municipal engineering department. Regular members may vote, serve on committees and hold office. Annual dues are $30.00. AFFILIATE MEMBER Employees in municipal engineering departments, Public Works Directors, Town Managers, etc. or representatives of TACT, Indiana LTAP, INDOT, FHWA, etc., with an unbiased and sincere interest in the Association. Note that the dues may be waived for qualifying affiliate members with approval of the Executive Board. Affiliate members may serve on committees but may not vote or hold office. Annual dues are $20.00. ASSOCIATE MEMBER Vendors, consultants or other "friends" of the Association. Associate members may participate in meetings but may not vote, serve on committees or hold office. Annual dues are $125.00. Make checks payable to: "IACE" and mail with this form to Cheryl Mencsik, Executive Secretary, IACE, P.O. Box 273, LaGrange, IN 46761. Our Federal EIN is 35- 2132826. Please reproduce form for applications for your employees, associates, etc. Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by Wet rates per day, number of hours, rate per hour, number of units, price per unit, etc. P yee c/o Cheryl Mencsik, Exec. Secretary Purchase Order No. OX 2 73 Terms LaGrange, IN 46761 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) n/a 2012 Membership Member" Gary Duncan ("Regu'ar Member Foley n u JLOLUO 20.00 r r $060 Total P 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 IN SUM OF c/o Cheryl Mencsik, Exec. S P.O. Box 273 LaGrange, IN 46.761 $80.00 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 E4G4355300 $80-00 bill(s) is (are) true and correct and that the na na materials or services itemized thereon for which charge is made were ordered and received except 20 l Sig ature Cost distribution ledger classification if Title claim paid motor vehicle highway fund