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Home My WebLink About212126 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 013514 Page 1 of 1 ONE CIVIC SQUARE APCO INTERNATIONAL, INC CARMEL, INDIANA 46032 351 N WILLIAMSON BLVD CHECK AMOUNT: $69.00 DAYTONA BEACH FL 32114-1112 CHECK NUMBER: 212126 CHECK DATE: 8/28/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4355300 HARRINGTON 69 . 00 ORGANIZATION & MEMBER Individual Membership Application Mail completed application with payment to: `i`/, APCO International Membership International 351 North Williamson Blvd. I Daytona Beach, FL 32114 ' Or Fax to 386.322.2501 or email membership@apcointl.org Your membership will be activated upon full payment of applicable dues. Leaders in Public Safety Communications" www.apcointi.org r•:Contact Information ,'_`� .,. .. �,� � ° n � a'' :;;. NAME Adam Harrington TILE Captain Carmel Fire Department ORGANIZATION AMATEUR CALL SIGN 2 Civic Square Carmel IN 46032 ORGANIZATION ADDRESS CITY STATE ZIP EMAIL aharrington @carmel.in.gov PHONE 3175712662 FAX 3175712615 HOME ADDRESS 19546 Tradewinds Dr CITY Noblesville STATE IN ZIP 46062 PRIMARY ADDRESS:❑HOME WORK REFERRED BY FUTURE INVOICES:❑BILL ME DIRECTLY Q BILL AGENCY GROUP `Mlembership Information _ Member Profile ❑Active: Tier One—$92.00 USD Agency Category—Please select the one that best fits. Individuals who are employed by,retired from,or volunteer for a governmental entity or a contractor for a governmental entity and are ❑Consolidated Dispatch Center Fire Department responsible for the management,design,construction,installation, ❑Emergency Management ❑Law Enforcement command,and operation of public safety communications systems ❑EMS ❑PSAP Training Officer and supporting information systems.Active members may vote on ❑Government Agency Other: association matters,enjoy all benefits and,except where otherwise limited,serve in any capacity in the association and its chartered groups. Job Classification—Please Select the one that best fits. ❑Active:Tier TWo—$120.00 USD ❑9-1-1 Coordinator ❑Sheriff Applicants as defined above in Tier One residing in California, ❑Director ❑Supervisor Louisiana and Oregon are to select this Tier.(Note:Tier selection/ ❑Engineer/Technician ❑Telecommunicator/Dispatcher membership dues are set by each respective Chapter). ❑Fire Chief ❑Training&Education/Coordinator Member—$69.00 USD El Information Systems ❑County/State Official ❑Manager F Other: Training Officer Individuals who are not eligible for either of the Active categories.Eligible individuals not working in administrative or supervisory roles may also ❑Police Chief choose this category if they are not interested in voting privileges. _p_a_ymenf Information Commercial members use application at: -� http://www.apcointl.org/new/membership/app_comm.php ❑i CHECK ENCLOSED 0 El AMEX El MASTERCARD ❑DISCOVER El VISA ❑Additional Chapters: CARD NUMBER Persons residing and/or permanently employed in the chartered area of a chapter are required to be members of such chartered Chapter. EXPIRATION DATE SECURITY CODE Members belonging to one Chapter may become a member of any other number of Chapters as outlined in the Bylaws. Please list the SIGNATURE additional Chapters by name: PRINT NAME CARDHOLDER'S EMAIL Mail completed application with payment to: #of Additional Tier 1 Chapters x$18.40 APCO International Membership 351 North Williamson Blvd.,Daytona Beach,Ft.32114 #of Additional Tier 2 Chapters x$46.40 or Fax to 386.322.2501 Total Due 69.00 Your membership will be activated upon full payment of applicable dues. *Note:$35 of your membership goes to your subscription to Public Safety Communications/APCO Bulletin Joumal.APCO International annual dues are not a deductible contribution for federal tax purposes,but may be deducted as a business expense.Public Safety Communications subscription price for one year($35)is included in membership dues and members may not deduct the subscription price from dues.APCO estimates that an additional 7.6%of your dues are not deductible because of APCO's lobbying activities on runs through the calendar year. See website for proration information. APCO International Membership 1 351 North Williamson Blvd.I Daytona Beach,FL 32114 1 www.apcointl.org MIMAP910 )rescribed by State Board of Accounts City Form No.201 (Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL Nn 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)) Harrington $69.00 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 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 APCO International Membership IN SUM OF $ 351 North Williamson Boulevard Daytona Beach, FL 32114 $69.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 I I 43-553.00 I $69.00 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 AUG a72(119 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund