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213359 10/09/2012 *f CITY OF CARMEL, INDIANA VENDOR: 356912 Page 1 of 1 ONE CIVIC SQUARE AMERICAN SOCIETY OF CIVIL ENGINEER CARMEL, INDIANA 46032 P.O.BOX 79084 CHECK AMOUNT: $240.00 +, BALTIMORE MD 21279-0084 CHECK NUMBER: 213359 CHECK DATE: 10/9/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2200 43SS300 240 . 00 ORGANIZATION & MEMBER AMERICAN SOCIETY OE CIVIL ENGINEERS P.O. BOX 79084, BALTIMORE, MD 21279-0084 I IIIII IIIIII I I IIIIIIIII II ��"°�." September 4, 2012 RENEW EARLY FOR A Michael Thomas Mc Bride, P.E., M.ASCE City of Carmel CHANCE TO WIN $101 14227 Turner Hollow PI Fishers, IN 46040-8113 jllli Renew your membership online at www.asce.org/renewal Address Update - Please note any changes in Step 3 on reverse side of form. _Instructions:To-maintain-your current level of membership and services,please submit the"Grand Total"amount. To amend your current levels,please circle any items you choose to pay in Step 1.Add additional items in the Step 2"write-in"column and include them in the"Grand Total." To choose or change your EWB Chapter,please call ASCE's Customer Service at(800)548-ASCE(2723)or(703)295-6300. Description Renewal Amount Code National Membership Dues _ $225.00 ND Indiana Section-Metro Indianapolis Branch Dues $15.00 SD Transportation and Development Inst Dues(TDI) $0.00 1 TDMP Annual Sub-total: $240.00 _ Description Write-in Amount Code Engineers Without Borders National Membership ($60.00) EO Engineers Without Borders Supporting Membership $40.00 E813 Architectural Engineering Institute Dues AEI $30.00 AEMS Coasts,Oceans,Ports and Rivers Inst Dues COPRI $30.00 COMS Construction Institute Dues(CI) $( 30.00) _ _ CIMS Engineerin Mechanics Institute Dues EMI $30.00 EMMS Environmental and Water Resources Inst Dues EWRI $30.00 EWMS Geo-Institute Dues G-I $30.00 GIMS Structural Engineering Institute Dues SEI $30.00 SEMS Int'I Soc of Soil Mech Geotechnical En ISSMGE $15.00 ISS Indiana Section-Metro Indianapolis Br Voluntary $25.00 SV National Funds Description See enclosed insert for descriptions Write-in Amount Write-in Code _ z —_j C-)- — m F- H� m Q� Institute Funds Description see enclosed insert for descriptions Write-in Amount Write-in Code _Z C)0 U Annual Sub-total: Turn Over for Payment Information , 368926 3 1 1042050508 1 TYPE A - MB USA 13 In order to ensure the accuracy of your record, please review all the information below and make changes where needed. Currently your preferred mailing address is: Residence. Change your preferred mailing address by circling your new preference: RESIDENCE or BUSINESS/SCHOOL COMPANY NAME: City of Carmel Currently your actual business title is: CITY ENGINEER, if this is not correct please mark through this and write in your changes here RESIDENCE ADDRESS BUSINESS/SCHOOL ADDRESS Line 1: 14227 Turner Hollow PI Line 1: Engineering Department Line 2: Line 2: One Civic Square Line 3: Line 3: Cam: Fortville City: Carmel _ State: IN State: IN Zip Code:46040 Zip Code:46032 Count a: United States Country: United States Home Phone: 317 747-7025 E-mail Address#1: mmcbride carmel.in.gov Business Phone: 317 571-2441 E-mail Address#2: — -Fax-Phone: - ' Online Account E-mail: mmcbride@carmel.m.gov - —- - Please place a check(X)in the box that best describes your business title and industry classification.This helps ASCE to better filter the most appropriate business information to you. Note:This information must be updated annually. X Standardized Business Title X Industry Classification Engineer in Training,Engineering Intern,Assistant Engineer,Junior 1 Consulting Firm (A) Engineer,Staff Engineer,Engineering Instructor 2 Architectural Firm Civil Engineer,Associate Engineer,Project Engineer,Resident (D) Engineer,Assistant Professor 3 Federal (E) Senior Engineer,Project Manager,Associate Professor 4 State,County,Township and District (F) Principal Engineer,District Engineer,Engineering Manager,Professor GOVERNMENT 5 Municipal Director,Program Manager,City Engineer,County Engineer,Division (G) Engineer,Department Head,Vice President 6 Military Bureau Engineer,Director of Public Works,Dean,President,Owner, 7 Engineering Schools (H) CEO (1) Other non-engineer,non-technical,non-sciences,student 8 Specializing in Highway and Heavy Construction (J) Retired 9 Specializing in Building Construction CONTRACTOR 10 Engaged in Both 8 and 9 Please sign -- Produceis of Building and Construction Materials and fvfanuflacturers of =_ 11 Construction Equipment and Supplies Professional and Trade Associations,Libraries,Clubs and Others Allied to the Signature Date 12 Field a Payment by Check:Check must be made payable to ASCE in equivalent U S.dollars. GRAND TOTAL: ® $240.00 Federal ID No.13-1635293.Checks not in U.S.dollars drawn on a U.S bank will be returned. Payment by Credit Card: ❑AMEX ❑Discover ❑MasterCard ❑Visa ❑Diners Club Please remit payment to: MEMBERSHIP DUES ARE DUE ASCE MEMBERSHIP, •• BOX BY DECEMBER 31,2012. Credit Card# Expiration Date 1 79084, • „• MEMBER#: 368926 •CORRESPONDENCE TO X B DD' INVOICE#: 1042050508 Signature 800 Thank you for renewing your membership. Your 2013 Membership Year begins on January 1, 2013. $25(or a pro-ration thereof)of your dues payment represents the non-deductible amount associated with the Civil Engineering magazine.The balance of your dues and all voluntary contributions may be deductible as a charitable contribution according to the I.R.S.Please consult your tax advisor. 368926 3 1 1042050508 1 TYPE A - MB USA 13 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 American Society of Civil Engineers Purchase Order No. POB.79084 Terms Baltimore, MD 21279-0084 Date Due Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s) Amount 9/4/2012 0 Annual Membership - Mike McBride $ 240.00 Total $ 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 VOUCHER NO WARRANT NO. American Society of Civil Engineers ALLOWED 20 POB 79084 IN SUM OF $ Baltimore, MD 21279-0084 $ 240.00 ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT# I hereby certify that the attached invoice(s), or 0 0 2200-4355300 240 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 10/8/2012 -.22� Signature City Engineer Cost Distribution ledger classification if Title claim paid motor vehicle highway fund