210039 06/20/2012 CITY OF CARMEL, INDIANA VENDOR: 00350077 Page 1 of 1
0 ONE CIVIC SQUARE INDIANA STREET COMM ASSOCIATION
CARMEL, INDIANA 46032 ATTN: LARRY LEE CHECK AMOUNT: $240.00
1301 LAFAYETTE AVE CHECK NUMBER: 210039
LEBANON IN 46052
CHECK DATE: 6/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4357004 240.00 EXTERNAL INSTRUCT FEE
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DIANA $fflIRT Il SIQI ERS� AT, 5tIATIO
2012 Annual Street Commissioners Convention
Registration Form:
August 14th 15 th 16 th
Name of Registrant vI'd (1,m
Address: o41c u 1 3 6 t
0, A0 1 .5-1, IN) ql o q
Phone: 1 6 3 —aoo
Spouse's Name (if attending): I^
E -Mail Address: r ►�m�'�® ��1ftt1� ,I11, pd �KII.Lf►� LQrn��(,l y
REGISTRATI ®N FEE MUST BE ENCLOSED WITH FORM
Current ISCA Member $120.00 (Convention Package)
l Asst. Commissioner /Forman $120.00 (Convention Package)
Other Additional Registrant $120.00 (Includes Meals)
Vendor Registration $300.00 (Includes Meals Vendor Cookout)
Booth Space (Includes 6 -ft table and two chairs) $200.00
(Limited booth area no more then 30 booth areas)
Note(s): Vendors must purchase a registration for each additional person in their
Group at the cost of $120.00:
All hotel accommodations must be made with a credit card at: FOUR POINTS by SHERATON
WEST LAFAYETTE
1600 Cumberland Avenue
West Lafayette, Indiana 47906
(T) 765 463 -5511 (F) 765 497 -3850
When making hotel reservations, let the hotel know you are with the Indiana Street
Commissioners Association. I.S.C.A.
*The room rate's are $99.00 dollars for I.S.C.A. members they will be guaranteed until July 16
After July 16 rooms will be released to the public. Cancellation must be made four days prior to
Arrival for full refund of deposit. Check -in time is at 3:00 p.m. Check -out is at 11:00
Vendors who want (hospitality rooms) must contact: John Welborn at 765 420 -1520 or E -mail
iwelborn @hicclaf.com
Please complete and return registration form with payment by July 16 2012:
(NAIL: CONVENTION REGISTRATION WITH PAYMENT TO
LARRY LEE SECRETARY /TREASURER
LEBANON STREET DEPARTMENT
1301 LAFAYETTE AVE
LEBANON, INDIANA 46052
VOUCHER NO. WARRANT NO.
ALLOWED 20
ISCA Con�areRe t ti
Larry Lee, ecret ry/ eeasu er Lebanon St. De IN SUM OF
1301 Lafayette Avenue
Lebanon, IN 46052
$240.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT
Board Members
2201 I I 43- 570.041 $240.00 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
m
Friday, ii n e 15, 2012
Street Commissionery
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))
06/01/12 $240.00
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